Vanommeslaeghe Floris, De Somer Filip, Josipovic Iván, Boone Matthieu, Dhondt Annemieke, Van Biesen Wim, Eloot Sunny
Nephrology, Ghent University Hospital, Ghent, Belgium.
Cardiac Surgery, Ghent University Hospital, Ghent, Belgium.
Artif Organs. 2019 Aug;43(8):756-763. doi: 10.1111/aor.13452. Epub 2019 Apr 7.
In patients with enhanced risk for bleeding, heparin-free hemodialysis (HD) with conventional dialyzers is routinely used. To explore the potential benefit of using heparin-coated dialyzers, we used a reference CT-scanning technique and registered different clotting parameters to quantify coagulation with heparin-coated versus non-coated dialyzers. Six HD patients with thrombocytopenia were dialyzed 240 min in a randomized crossover study with Evodial 1.3 or FX600 Cordiax, each without anticoagulation. Blood samples were taken from the vascular access predialysis, and from the dialyzer inlet and outlet at 5 and 240 min after dialysis start. Predialysis blood samples were analyzed for hemoglobin, hematocrit, thrombocytes, fibrinogen, and activated partial thromboplastin time. On dialyzer inlet and outlet blood samples, a viscoelastic measurement of blood coagulation was performed using a Sonoclot analyzer. After dialysis, dialyzers were visually scored, subsequently dried for 24 h, weighed, and scanned with micro-CT at a resolution of 25 µm. After image reconstruction, the open, non-coagulated fibers were counted in a representative cross-section at the dialyzer outlet. No sessions were terminated prematurely for circuit clotting. Heparin-coated dialyzers had more patent fibers on micro-CT versus non-coated dialyzers and also had a better score of subjective visual assessment of fiber clotting. There was no difference in subjective assessment of clotting at the venous drip chamber. With both dialyzers, all ACT values remained in the normal range, and were lower at the dialyzer outlet versus inlet. In conclusion, dialysis with a heparin-coated versus non heparin-coated membrane results in substantially less coagulated fibers during 4 h hemodialysis without systemic anticoagulation. Eventual leaching of heparin, immobilized on the fiber membrane, does not result in measurable systemic anticoagulation.
对于出血风险增加的患者，常规使用无肝素血液透析（HD）结合传统透析器。为了探索使用肝素涂层透析器的潜在益处，我们采用了一种参考CT扫描技术，并记录不同的凝血参数，以量化肝素涂层透析器与非涂层透析器的凝血情况。在一项随机交叉研究中，6名血小板减少的HD患者使用Evodial 1.3或FX600 Cordiax进行了240分钟的透析，均未使用抗凝剂。在透析开始前从血管通路采集血样，并在透析开始后5分钟和240分钟从透析器入口和出口采集血样。对透析前血样进行血红蛋白、血细胞比容、血小板、纤维蛋白原和活化部分凝血活酶时间分析。在透析器入口和出口血样上，使用Sonoclot分析仪对血液凝固进行粘弹性测量。透析后，对透析器进行视觉评分，随后干燥24小时，称重，并以25μm的分辨率用微型CT扫描。图像重建后，在透析器出口的代表性横截面中计算开放的、未凝固的纤维数量。没有因回路凝血而提前终止任何透析疗程。与非涂层透析器相比，肝素涂层透析器在微型CT上有更多的通畅纤维，并且在纤维凝血的主观视觉评估中得分更高。静脉滴注室的凝血主观评估没有差异。使用两种透析器时，所有活化凝血时间（ACT）值均保持在正常范围内，且透析器出口处的值低于入口处。总之，在无全身抗凝的4小时血液透析过程中，使用肝素涂层膜与非肝素涂层膜透析相比，凝固纤维显著减少。固定在纤维膜上的肝素最终释放不会导致可测量的全身抗凝。
