Coene Karlien L M, Dekker Marijke J E, Kerskes Marieke C H M, Hengst Maaike, Schonck Marc J M, Konings Constantijn J A M, Scharnhorst Volkher
Clinical Laboratory, Catharina Hospital Eindhoven, Eindhoven, The Netherlands.
Nephron. 2017;137(3):205-211. doi: 10.1159/000479390. Epub 2017 Aug 18.
BACKGROUND/AIMS: Anticoagulation of the extracorporeal circuit is essential for adequate haemodialysis (HD). Low molecular weight heparins (LMWHs) are safe and sufficient towards achieving this goal. In the Netherlands, dosage is based on bodyweight and adjusted based on clinical events. LMWH levels during dialysis can be quantified through measurement of the anti-Xa activity and a target range of 0.5-1.0 IU/mL has been proposed. We aimed to evaluate the practical value of the anti-Xa activity to guide LMWH dosage in HD patients. Additionally, the value of the activated partial thromboplastin time (APTT) was investigated.
All prevalent adult HD patients of our dialysis clinic were included. APTT and anti-Xa activity were measured before, during and after 2 dialysis sessions. Clinical and dialysis characteristics, including LMWH dosage, were derived from digital patient charts.
Our final study cohort consisted of 83 patients. LMWH dosage during dialysis was appropriate for bodyweight in 61% of cases, of which 50% reached an anti-Xa activity within the putative target range of 0.5-1.0 IU/mL. Forty-six percent of patients had an anti-Xa activity >1.0 IU/mL. Anti-Xa levels during and after dialysis were significantly correlated (r = 0.803, p < 0.01). No thrombotic or haemorrhagic complications were observed in this study. Correlation of APTT with anti-Xa activity was poor.
Anti-Xa activity measurements during dialysis can identify patients in whom LMWH dosage should be lowered in a subsequent dialysis session. Whether such an intervention leads to a decrease in haemorrhagic complications needs to be evaluated in prospective studies.
背景/目的：体外循环抗凝对于充分的血液透析（HD）至关重要。低分子量肝素（LMWHs）在实现这一目标方面安全且有效。在荷兰，剂量基于体重并根据临床情况进行调整。透析期间的LMWH水平可通过测量抗Xa活性来量化，已提出目标范围为0.5 - 1.0 IU/mL。我们旨在评估抗Xa活性在指导HD患者LMWH剂量方面的实用价值。此外，还研究了活化部分凝血活酶时间（APTT）的价值。
纳入我们透析诊所所有成年HD患者。在2次透析治疗前、治疗期间和治疗后测量APTT和抗Xa活性。临床和透析特征，包括LMWH剂量，来自数字患者病历。
我们的最终研究队列包括83名患者。61%的病例透析期间的LMWH剂量适合体重，其中50%的患者抗Xa活性达到0.5 - 1.0 IU/mL的假定目标范围。46%的患者抗Xa活性>1.0 IU/mL。透析期间和透析后的抗Xa水平显著相关（r = 0.803，p < 0.01）。本研究中未观察到血栓形成或出血并发症。APTT与抗Xa活性的相关性较差。
透析期间测量抗Xa活性可识别出在随后的透析治疗中应降低LMWH剂量的患者。这种干预是否会导致出血并发症的减少需要在前瞻性研究中进行评估。
