Platelet-related hemostasis before and after hemodialysis with five different anticoagulation methods.

PURPOSE

To evaluate platelet-related hemostasis during hemodialysis performed with five different anticoagulation methods.

METHODS

31 chronic hemodialysis patients, 71% men, aged 57.5 ± 17.4 years, participated in our prospective study. Platelet function analyzer PFA -100 closure time (collagen/epinephrine -CEPI, collagen/adenosine diphosphate -CADP) was measured before and after hemodialysis, which was performed consecutively with five different anticoagulation methods: full-dose unfractionated heparin (UFH) and low-molecular weight heparin (LMWH): 31 patients, regional citrate anticoagulation (RCA): 28 patients, low-dose heparin: 25 patients and "heparin-free'' dialysis: 9 patients. The degree of clotting in the dialysis system was graded on a 5 point scale.

RESULTS: CEPI (mean ± SD, reference range 80-160 sec) before vs. after hemodialysis: UFH: 171.7 ± 62.1 vs. 170.8 ± 67.3; LMWH: 167.4 ± 56.9 vs. 159.4 ± 56.4; low-dose heparin: 175.3 ± 69.0 vs. 183.1 ± 
60.5; RCA: 172.6 ± 57.4 vs. 161.6 ± 57.0; "heparin-free'': 181.7 ± 56.8 vs. 209.0 ± 66.5; all differences nonsignificant. CADP (mean ± SD, reference range: 68-121 sec) before vs. after hemodialysis: UFH: 132.0 ± 56.6 vs.146.3 ± 68.4; LMWH: 132.4 ± 57,0 vs. 123.1 ± 50.8; low-dose heparin: 137.2 ± 64.2 vs. 143.8 ± 55.5; RCA: 140.7 ± 48.2 vs. 132.9 ± 48.1; "heparin-free'': 137.1 ± 68.0 vs.139.2 ± 29.7; all differences nonsignificant. Before hemodialysis procedure CEPI was increased in 51.2% and CADP in 48.4% of the patients. The best dialysis system clotting score was found with UFH, LMWH and RCA.

CONCLUSIONS

Platelet dysfunction was demonstrated in approximately half of the chronic hemodialysis patients and was not improved after hemodialysis, regardless of the anticoagulation regimen used.