Le Suivi Biologique de l’Héparinothérapie Chez les Hémodialysés Chroniques par Mesure de l’Activité Anti-Xa Plasmatique "Revue de Littérature

Abstract

Effective anticoagulation is essential in hemodialysis (HD) to maintain the permeability of the extracorporeal circuit (ECC), thus preventing coagulation and unwanted blood loss. Low molecular weight heparins (LMWH) have been shown to safe and effective for this purpose. Monitoring of this efficacy is monitored by assessing anti-Xa activity in plasma, however, it is not well defined especially as clinical effects are often unpredictable in hemodialysis patients. The aim of this study is to assess the practical value of measuring anti-Xa activity in adjusting the dose of LMWH and predicting the anticoagulant effect during the HD session Methods : The studies were identified from the PUBMED, SCIENCEDIRECT databases and the GOOGLE SCHOLAR search engine, with no date or language restriction. Randomized controlled trials evaluating the importance of measuring anti-Xa activity in adjusting the dose of LMWH during hemodialysis in patients with ESRD and reporting anti-Xa levels and at least bleeding or thrombosis of the extracorporeal circuit were chosen. Result: Seven trials were included in this review. It was found that there is a discrepancy between studies regarding the correlation between anti-Xa activity and clot formation in CEC. In addition, our review corroborates the results obtained from numerous studies demonstrating the absence of bioaccumulation of anti-Xa activity of LMWHs between dialysis sessions. Conclusion: The limited number of results and their heterogeneity depending on the initial doses and the time of peak of anti-Xa activity do not allow to predict an individualized initial dose, or an anti-Xa activity to be aimed as safe as it is75 effective. . Larger studies are needed to assess the clinical implication of the antiXa test in these patients.