Schilder Louise, Nurmohamed S Azam, ter Wee Pieter M, Paauw Nanne J, Girbes Armand R J, Beishuizen Albertus, Beelen Robert H J, Groeneveld A B Johan
Department of Nephrology, VU University Medical Center and Institute for Cardiovascular Research, Amsterdam, The Netherlands.
Blood Purif. 2015;39(4):297-305. doi: 10.1159/000380904. Epub 2015 May 6.
The mechanisms of early filter failure and clotting with different anticoagulation modalities during continuous venovenous hemofiltration (CVVH) are largely unknown.
Citrate, heparin and no anticoagulation were compared. Blood was drawn pre- and post filter up to 720 min. Concentrations of the thrombin-antithrombin (TAT), activated protein C-protein C inhibitor (APC-PCI), and type I plasminogen activator inhibitor (PAI-1) were determined.
In case of early filter failure (<24 h), inlet concentrations of TAT and APC-PCI were higher over time, irrespective of anticoagulation. There was more production of APC-PCI and platelet-derived PAI-1 in the filter after 10 min in the heparin group than in other groups. In clotting filters, production of APC-PCI and PAI was also higher with heparin than citrate.
Coagulation activation in plasma and inhibition of anticoagulation in plasma and filter may partly determine early CVVH filter failure due to clotting, particularly when heparin is used. Regional anticoagulation by citrate circumvents the inhibition of anticoagulation and fibrinolysis by platelet activation following heparin.
在持续静静脉血液滤过（CVVH）期间，不同抗凝方式下早期滤器失效和凝血的机制在很大程度上尚不清楚。
比较了枸橼酸盐、肝素和无抗凝三种情况。在滤器前后抽取血液，最长至720分钟。测定凝血酶 - 抗凝血酶（TAT）、活化蛋白C - 蛋白C抑制剂（APC - PCI）和I型纤溶酶原激活物抑制剂（PAI - 1）的浓度。
在早期滤器失效（<24小时）的情况下，无论采用何种抗凝方式，TAT和APC - PCI的入口浓度均随时间升高。肝素组在10分钟后滤器中APC - PCI和血小板衍生的PAI - 1的产生量高于其他组。在凝血滤器中，肝素组的APC - PCI和PAI的产生量也高于枸橼酸盐组。
血浆中的凝血激活以及血浆和滤器中抗凝作用的抑制可能部分决定了因凝血导致的早期CVVH滤器失效，尤其是在使用肝素时。枸橼酸盐进行局部抗凝可避免肝素后血小板激活对抗凝和纤维蛋白溶解的抑制。
