Keller F, Seemann J, Preuschof L, Offermann G
Steglitz University Hospital, Free University of Berlin Department for General Internal Medicine and Nephrology, West Germany.
Nephrol Dial Transplant. 1990;5(9):802-7. doi: 10.1093/ndt/5.9.802.
Heparin-free haemodialysis must be considered for all dialysis patients with a risk of haemorrhage. This technique is associated with increased danger of system coagulation with a blood loss of up to 250 ml. In 84 patients with a risk of haemorrhage, 296 heparin-free haemodialyses were recorded prospectively. First signs of coagulation were found very much more frequently in the venous airtrap than in the dialyser (146 vs 42). System coagulation occurred in 13 of the 296 dialyses (4%) and was prevented by prophylactic switching of the system and dialyser in 140 dialyses (47%). The time of system coagulation was on average 1.8 hours (+/- 0.2) after the beginning of dialysis. The 13 patients with system coagulation had a reduced blood flow on dialysis (217 +/- 52 vs 240 +/- 36 ml/min). Their initially normal clotting time (12 +/- 5 vs 14 +/- 4 min) was more significantly shortened after 2 h (4 +/- 3 vs 8 +/- 3 min). The activities of antithrombin III (87 +/- 34% vs 88 +/- 39%) and protein C (66 +/- 45% vs 59 +/- 37%) do not differ from those of 47 other patients, even at the time of system coagulation, as measured in five patients (92 +/- 34% for antithrombin III, 51 +/- 29% for protein C). System coagulation and shortening of clotting time thus cannot be regarded as a consequence of absorption of these inhibitory factors of plasmatic coagulation. The danger of system coagulation in heparin-free haemodialysis could probably be further reduced by an improvement of the biocompatibility of systems (airtrap) and dialysers (less activation of thrombocytes).
对于所有有出血风险的透析患者，必须考虑采用无肝素血液透析。该技术与系统凝血风险增加相关，失血可达250毫升。前瞻性记录了84例有出血风险患者的296次无肝素血液透析。凝血的最初迹象在静脉空气捕捉器中比在透析器中更频繁出现（146次对42次）。296次透析中有13次（4%）发生系统凝血，140次透析（47%）通过预防性更换系统和透析器得以预防。系统凝血时间平均在透析开始后1.8小时（±0.2）。发生系统凝血的13例患者透析时血流量减少（217±52对240±36毫升/分钟）。他们最初正常的凝血时间（12±5对14±4分钟）在2小时后更显著缩短（4±3对8±3分钟）。即使在系统凝血时，抗凝血酶III（87±34%对88±39%）和蛋白C（66±45%对59±37%）的活性与其他47例患者相比并无差异，在5例患者中测量（抗凝血酶III为92±34%，蛋白C为51±29%）。因此，系统凝血和凝血时间缩短不能被视为血浆凝血抑制因子吸收的结果。通过改善系统（空气捕捉器）和透析器的生物相容性（减少血小板激活），无肝素血液透析中系统凝血的风险可能会进一步降低。
