Barata J D, Oliveira C, Bruges M, Gusmão L, Santana A, Ponce P, Simões J, Freire I, Crespo F, da Silva A N
Serviço de Nefrologia, Hospital Santa Cruz, Carnaxide, Sanofi Portugal.
Acta Med Port. 1992 Feb;5(2):65-70.
To test the efficacy and safety of a low molecular. Weight heparin (LMWH)--Fraxiparine, for hemodialysis (HD) anticoagulation, compared with conventional heparin (H) or serum lavage without other anticoagulation (L).
Prospective controlled study.
Twenty-nine consecutive patients referred for dialysis in a tertiary care hospital were divided in 3 groups A, B and C, each group A and B patient submitted to 2 dialysis, AI and AII, BI and BII. Group A--n = 10, no bleeding risk, single needle technique, blood flow (Qb) less than 200 ml/min. HD-AI used LMWH 10,000 U pre-HD, HD-AII used H for an ACT 1.5 to 2 times baseline; group B--n = 10, high bleeding risk, double needle dialysis, Qb--200 to 300 ml/min. HD-BI used LMWH 5000 U pre-HD, and HD-BII used only L; Group C--n = 9, no bleeding risk, Qb less than 200 ml/min, all received LMWH 5000 U pre-HD. A semiquantitative screening was done in each dialysis for the presence of dialyser or venous chamber clots, APTT and Anti Xa activity were measured every 30 min., as well as pre and post-dialysis Hb, Htc, and platelets.
APTT didn't rise significantly during HD with LMWH in contrast with the AII group with H (32.2 +/- 7.1 vs 63 +/- 25.8, p less than 0.05). The APTT levels in all dialysis with LMWH were identical to BII dialysis With L. Anti xa activity had an early peak at 30 to 60 min. With LMWH (0.62 +/- 0.45 em AI) and a late one at 180 min with H (0.39 +/- 0.2). There was no significant differences between pre and post-dialysis corrected platelet counts, but the lavage group showed the greater decrements (-20% +/- 24). In all the 49 dialysis we had 5 cases of complete clotting of the blood circuit, all of them in the lavage group C. No patients with high risk of hemorrhage had any bleeding increment.
LMWH prevents clotting as effectively as H, in low doses of 5000 anti Xa units it doesn't interfere with PTT and is far more effective than HD with serum lavage in patients with bleeding risk and/or low blood flow in the dialysis circuit.
比较低分子量肝素（LMWH）——速碧林与传统肝素（H）或无其他抗凝措施的血清冲洗（L）用于血液透析（HD）抗凝的有效性和安全性。
前瞻性对照研究。
一家三级护理医院中连续29例接受透析的患者被分为A、B、C三组，A组和B组的每位患者均接受2次透析，即AⅠ和AⅡ、BⅠ和BⅡ。A组——n = 10，无出血风险，采用单针技术，血流量（Qb）小于200 ml/min。HD - AⅠ在透析前使用10,000 U的LMWH，HD - AⅡ使用肝素使活化凝血时间（ACT）达到基线的1.5至2倍；B组——n = 10，高出血风险，采用双针透析，Qb为200至300 ml/min。HD - BⅠ在透析前使用5000 U的LMWH，HD - BⅡ仅采用L；C组——n = 9，无出血风险，Qb小于200 ml/min，均在透析前接受5000 U的LMWH。每次透析均进行半定量筛查以检测透析器或静脉腔是否有血栓形成，每30分钟测量活化部分凝血活酶时间（APTT）和抗Xa活性，以及透析前后的血红蛋白（Hb）、血细胞比容（Htc）和血小板。
与使用肝素的AⅡ组相比，使用LMWH进行血液透析期间APTT未显著升高（32.2±7.1 vs 63±25.8，p < 0.05）。所有使用LMWH进行透析的APTT水平与使用L的BⅡ组透析相同。使用LMWH时抗Xa活性在30至60分钟出现早期峰值（0.62±0.45 em AⅠ），而使用肝素时在180分钟出现晚期峰值（0.39±0.2）。透析前后校正血小板计数无显著差异，但冲洗组血小板计数下降幅度更大（-20%±24）。在所有49次透析中，我们有5例血液回路完全凝血的情况，均发生在冲洗组C。无高出血风险患者出现出血增加。
低分子量肝素在预防凝血方面与肝素同样有效，低剂量5000抗Xa单位时不干扰部分凝血活酶时间（PTT），并且在有出血风险和/或透析回路血流量低的患者中比血清冲洗血液透析更有效。
