Charles Pierre-Yves, Le Meur Yannick, Tanquerel Tugdual, Galinat Hubert
Department of Nephrology, University Hospital La Cavale Blanche, Université de Bretagne Occidentale, Brest, France.
Haematology Laboratory, University Hospital La Cavale Blanche, Université de Bretagne Occidentale, Brest, France.
Clin Kidney J. 2019 Oct 10;13(4):647-653. doi: 10.1093/ckj/sfz131. eCollection 2020 Aug.
In dialysis sessions, some data suggest that decreasing or even avoiding additional anticoagulation by heparin is possible among patients already treated with oral anticoagulation. However, the required dose of heparin may actually depend on the pre-dialysis international normalized ratio (INR), which varies from one session to another. The aim of our study was to determine the respective role of INR and heparin dosing in the risk of circuit clotting during chronic haemodialysis.
From early 2012 to July 2016, we analysed the totality of dialysis sessions performed at Brest University Hospital among haemodialysis patients treated by vitamin K antagonists (VKA). We established a prediction of circuit clotting on the basis of a simplified score obtained by combining INR and heparin dosing.
In total, 7184 dialysis sessions among chronic haemodialysis patients under VKA were identified, including 233 with clotting events. The mean INR without clotting events was 2.5 versus 1.8 with clotting events (P). Frequencies of circuit clotting were different according to INR group (INR <2.0, INR 2.0-3.0, INR >3.0; P). The protective role of VKA was higher than heparin, as shown by discriminant factor analysis (P. Our study established a predictive model of thrombosis risk of dialysis circuits in patients treated by VKA for a given heparin dose and a given INR. This model shows a marginal contribution of heparin to protect against the risk of thrombosis compared with VKA. Moreover, heparin would not appear to be necessary for patients with an INR >2.2.
在透析治疗过程中，一些数据表明，对于已经接受口服抗凝治疗的患者，减少甚至避免额外使用肝素进行抗凝是可行的。然而，肝素的所需剂量实际上可能取决于透析前的国际标准化比值（INR），而该比值在不同的透析疗程中有所变化。我们研究的目的是确定INR和肝素剂量在慢性血液透析过程中回路凝血风险方面各自所起的作用。
从2012年初至2016年7月，我们分析了布雷斯特大学医院对接受维生素K拮抗剂（VKA）治疗的血液透析患者进行的所有透析疗程。我们基于通过结合INR和肝素剂量获得的简化评分建立了回路凝血的预测模型。
总共识别出7184例接受VKA治疗的慢性血液透析患者的透析疗程，其中233例发生了凝血事件。无凝血事件的患者平均INR为2.5，而发生凝血事件的患者为1.8（P值）。根据INR组（INR<2.0、INR 2.0 - 3.0、INR>3.0），回路凝血的频率有所不同（P值）。判别因子分析表明，VKA的保护作用高于肝素（P值）。我们的研究建立了在给定肝素剂量和给定INR情况下，接受VKA治疗的患者透析回路血栓形成风险的预测模型。该模型显示，与VKA相比，肝素对预防血栓形成风险的贡献较小。此外，对于INR>2.2的患者，似乎不需要使用肝素。
