Brunetta Gavranić Bruna, Bašić-Jukić Nikolina, Premužić Vedran, Kes Petar
Department of Nephrology, Arterial Hypertension, Dialysis, and Transplantation, University Hospital Centre Zagreb, Zagreb, Croatia.
J Clin Apher. 2017 Dec;32(6):479-485. doi: 10.1002/jca.21544. Epub 2017 May 9.
Administration of an anticoagulant during therapeutic plasma exchange (TPE) is necessary to avoid circuit clotting and impaired treatment effectiveness. Citrate is the preferred anticoagulant for apheresis worldwide, and unfractionated heparin (UH) is the second most preferred, yet there are only a few published studies regarding the use of UH during TPE. There are even fewer studies regarding the use of low-molecular-weight heparin (LMWH) and TPE performed without anticoagulation.
We retrospectively analyzed the database of the Department of Nephrology at Zagreb University Hospital Center from 1982 to 2014 to test the safety of various heparin anticoagulation in TPE. We grouped procedures according to anticoagulation type (UH, LMWH, and no anticoagulation) and compared differences in the use of anticoagulants during our study period, patient populations, replacement fluids, and complications.
Complications were recorded during 11.1% of the 9,501 procedures. The incidence of any recorded complication was significantly higher in the LMWH group (21.2%) compared to the group with no anticoagulation (16.3%) and the UH group (9.5%) (P < 0.001). Similarly, the blood clotting in the extracorporeal circuit was most common in the LMWH group (LMWH, 12.0%; no anticoagulation, 6.3%; UH, 2.4%; P < 0.001). Incidents of bleeding complications were very low and occurred during or after 13 TPE sessions (0.1% of all procedures).
Our findings indicate that TPE procedures can be conducted safely with UH and, when necessary, without anticoagulation. The use of LMWH was associated with more complications when compared with use of UH and to TPE done without anticoagulation. Further studies are necessary to study its use during TPE procedures.
在治疗性血浆置换（TPE）过程中使用抗凝剂对于避免体外循环凝血和治疗效果受损是必要的。枸橼酸盐是全球血液成分单采术首选的抗凝剂，普通肝素（UH）是第二常用的抗凝剂，然而关于TPE过程中使用UH的已发表研究较少。关于使用低分子肝素（LMWH）和无抗凝剂进行TPE的研究更少。
我们回顾性分析了萨格勒布大学医院中心肾脏病科1982年至2014年的数据库，以测试TPE中各种肝素抗凝的安全性。我们根据抗凝类型（UH、LMWH和无抗凝）对操作进行分组，并比较了研究期间抗凝剂的使用差异、患者群体、置换液和并发症。
在9501例操作中，11.1%记录到并发症。与无抗凝组（16.3%）和UH组（9.5%）相比，LMWH组任何记录到的并发症发生率显著更高（21.2%）（P < 0.001）。同样，体外循环中的血液凝固在LMWH组最为常见（LMWH组为12.0%；无抗凝组为6.3%；UH组为2.4%；P < 0.001）。出血并发症的发生率非常低，在13次TPE治疗期间或之后发生（占所有操作的0.1%）。
我们的研究结果表明，TPE操作使用UH可以安全进行，必要时也可无抗凝剂进行。与使用UH和无抗凝剂的TPE相比，使用LMWH与更多并发症相关。有必要进一步研究其在TPE操作中的使用情况。
