Dhondt Annemieke, Pauwels Ruben, Devreese Katrien, Eloot Sunny, Glorieux Griet, Vanholder Raymond
Department of Nephrology, Ghent University Hospital, Ghent, Belgium.
Coagulation Laboratory, Department of Clinical Chemistry, Microbiology and Immunology, Ghent University Hospital, Ghent, Belgium.
PLoS One. 2015 Jun 15;10(6):e0128634. doi: 10.1371/journal.pone.0128634. eCollection 2015.
Low molecular weight heparins (LMWHs) are small enough to pass large pore dialysis membranes. Removal of LMWH if injected before the start of the session is possible during high-flux dialysis and hemodiafiltration. The aim of this study was to determine the optimal mode (place and time) of tinzaparin administration during postdilution hemodiafiltration.
STUDY DESIGN, SETTING, PATIENTS: In 13 chronic hemodiafiltration patients, 3 approaches of injection were compared in a randomised cross over trial: i) before the start of the session at the inlet blood line filled with rinsing solution (IN0), ii) 5 min after the start at the inlet line filled with blood (IN5) and iii) before the start of the session at the outlet blood line (OUT0). Anti-Xa activity, thrombin generation, visual clotting score and reduction ratios of urea and beta2microglobulin were measured.
Anti-Xa activity was lower with IN0 compared with IN5 and OUT0, and also more thrombin generation was observed with IN0. No differences were observed in visual clotting scores and no clinically relevant differences were observed in solute reduction ratio. An anti-Xa of 0.3 IU/mL was discriminative for thrombin generation. Anti-Xa levels below 0.3 IU/mL at the end of the session were associated with worse clotting scores and lower reduction ratio of urea and beta2microglobulin.
Injection of tinzaparin at the inlet line before the start of postdilution hemodiafiltration is associated with loss of anticoagulant activity and can therefore not be recommended. Additionally, we found that an anti-Xa above 0.3 IU/mL at the end of the session is associated with less clotting and higher dialysis adequacy.
Clinicaltrials.gov NCT00756145.
低分子量肝素（LMWHs）分子量小，能够通过大孔径透析膜。在高通量透析和血液透析滤过过程中，如果在治疗开始前注射低分子量肝素，有可能将其清除。本研究的目的是确定在后置稀释血液透析滤过过程中替扎肝素给药的最佳方式（部位和时间）。
研究设计、地点、患者：在13例慢性血液透析滤过患者中，通过随机交叉试验比较了3种注射方法：i）在治疗开始前于充满冲洗液的入血管路处注射（IN0），ii）在开始后5分钟于充满血液的入血管路处注射（IN5），iii）在治疗开始前于出血管路处注射（OUT0）。测定了抗Xa活性、凝血酶生成、视觉凝血评分以及尿素和β2微球蛋白的清除率。
与IN5和OUT0相比，IN0时的抗Xa活性较低，且IN0时观察到更多的凝血酶生成。视觉凝血评分无差异，溶质清除率也无临床相关差异。抗Xa水平为0.3 IU/mL可区分凝血酶生成情况。治疗结束时抗Xa水平低于0.3 IU/mL与较差的凝血评分以及较低的尿素和β2微球蛋白清除率相关。
在后置稀释血液透析滤过开始前于入血管路处注射替扎肝素会导致抗凝活性丧失，因此不推荐这种方法。此外，我们发现治疗结束时抗Xa水平高于0.3 IU/mL与较少的凝血和较高的透析充分性相关。
Clinicaltrials.gov NCT00756145。
