Nigten Jeannet, de Groot Karina A, Grootendorst Diana C, Koolen Stijn L W, Herruer Martien H, Schut Niels H
Atal-Medial-Medical Diagnostic Centres, Hoofddorp, The Netherlands.
Nephron Clin Pract. 2013;124(3-4):179-83. doi: 10.1159/000356384. Epub 2013 Dec 24.
BACKGROUND/AIMS: Usually, the appropriate dosage of low-molecular-weight heparin during haemodialysis is empirically based on the clinical effect. We studied the pharmacokinetics of dalteparin during standard haemodialysis in different groups of patients to assess the added value of measuring the anti-Xa activity for dose monitoring and adjustments.
The pharmacokinetics of intravenously administered dalteparin during haemodialysis was studied in 9 patients during 27 haemodialysis sessions. Six patients received a single bolus dose of dalteparin (group 1), and 3 patients received a higher initial bolus dose of dalteparin followed by a second bolus dose after 2 h (group 2). The clinical effect was evaluated by visual inspection for clot formation in the extracorporeal circuit.
The pharmacokinetic curve suggests a zero-order process of elimination. The mean decrease in anti-Xa activity (slope) was comparable in all patients. The mean anti-Xa activity at the end of haemodialysis (Clast) was 0.15 IU/ml in group 1 and 0.60 IU/ml in group 2.
We conclude that measuring anti-Xa activity can be used to monitor the elimination of dalteparin during haemodialysis and is highly reproducible.
背景/目的：通常，血液透析期间低分子量肝素的合适剂量是基于临床效果凭经验确定的。我们研究了不同患者组在标准血液透析期间达肝素的药代动力学，以评估测量抗Xa活性用于剂量监测和调整的附加价值。
在9例患者的27次血液透析疗程中研究了血液透析期间静脉注射达肝素的药代动力学。6例患者接受单次推注剂量的达肝素（第1组），3例患者接受较高初始推注剂量的达肝素，2小时后再接受第二次推注剂量（第2组）。通过肉眼观察体外循环中血栓形成来评估临床效果。
药代动力学曲线提示为零级消除过程。所有患者抗Xa活性的平均下降（斜率）相当。血液透析结束时（C末）的平均抗Xa活性在第1组为0.15 IU/ml，在第2组为0.60 IU/ml。
我们得出结论，测量抗Xa活性可用于监测血液透析期间达肝素的消除，且具有高度可重复性。
