Krummel Thierry, Scheidt Elise, Borni-Duval Claire, Bazin Dorothée, Lefebvre François, Nguyen Philippe, Hannedouche Thierry
Department of Nephrology, University Hospital and School of Medicine, Strasbourg, France.
Nephrol Dial Transplant. 2014 Apr;29(4):906-13. doi: 10.1093/ndt/gft522. Epub 2014 Jan 23.
Anticoagulation for the haemodialysis circuit in patients treated with oral anticoagulation poses additional haemorrhagic risk. The few available data suggest that tapering or even stopping heparinization is feasible and the HeprAN membrane with grafted heparin was developed to decrease heparin dose. The objective of our study was to evaluate the need for additional anticoagulation in patients on long-term oral anticoagulation, according to the type of membrane used.
This is a prospective, randomized, crossover bifactorial trial in haemodialysed patients on oral anticoagulation. Each patient had four haemodialysis sessions with two different membranes [HeprAN or polysulphone (PS)] and with or without enoxaparin. Clinical coagulation was evaluated by the need for premature ending and by a visual score (Janssen scale). Coagulation activation markers were also measured: d-dimers, prothrombin fragments 1 + 2, thrombin-antithrombin complexes, tissue factor pathway inhibitor and platelet factor-4.
Ten patients were included (M/F = 4/6, mean age 63 ± 15 years). None of the 40 sessions ended prematurely. The clotting scores were similar with or without enoxaparin (dialyser: 1.49 ± 0.19 versus 1.53 ± 0.17, P = 0.97; bubble trap: 0.75 ± 0.19 versus 0.78 ± 0.22, P = 0.62) and with the polysulphone or the HeprAN membrane (dialyser: 1.54 ± 0.20 versus 1.47 ± 0.16, P = 0.65; bubble trap: 0.74 ± 0.22 versus 0.79 ± 0.19, P = 0.58). There was no significant difference in coagulation activation markers between dialysis modalities; however, dialysis efficacy was significantly greater with the PS membrane (1.58 ± 0.07 versus 1.43 ± 0.06, P = 0.02).
These results suggest that haemodialysis without additional anticoagulation is possible in patients with oral anticoagulation. The HeprAN membrane did not provide any additional benefit compared with a PS membrane.
接受口服抗凝治疗的患者，其血液透析回路的抗凝会带来额外的出血风险。现有的少量数据表明，逐渐减少甚至停止肝素化是可行的，并且已开发出带有接枝肝素的HeprAN膜以减少肝素剂量。我们研究的目的是根据所用膜的类型，评估长期接受口服抗凝治疗的患者是否需要额外抗凝。
这是一项针对接受口服抗凝治疗的血液透析患者的前瞻性、随机、交叉双因素试验。每位患者进行四次血液透析，使用两种不同的膜（HeprAN或聚砜（PS）），并分别在有或没有依诺肝素的情况下进行。通过是否需要提前结束以及视觉评分（杨森量表）评估临床凝血情况。还测量了凝血激活标志物：D - 二聚体、凝血酶原片段1 + 2、凝血酶 - 抗凝血酶复合物、组织因子途径抑制剂和血小板因子4。
纳入10名患者（男/女 = 4/6，平均年龄63±15岁）。40次透析均未提前结束。有或没有依诺肝素时的凝血评分相似（透析器：1.49±0.19对1.53±0.17, P = 0.97；气泡捕集器：0.75±0.19对0.78±0.22, P = 0.62），使用聚砜膜或HeprAN膜时也相似（透析器：1.54±0.20对1.47±0.16, P = 0.65；气泡捕集器：0.74±0.22对0.79±0.19, P = 0.58）。不同透析方式之间凝血激活标志物无显著差异；然而，PS膜的透析效果显著更好（1.58±0.07对1.43±0.06, P = 0.02）。
这些结果表明，接受口服抗凝治疗的患者在不进行额外抗凝的情况下也可以进行血液透析。与PS膜相比，HeprAN膜没有提供任何额外益处。
