Lane D A, Flynn A, Ireland H, Anastassiades E, Curtis J R
Haemostasis. 1986;16 Suppl 2:38-47. doi: 10.1159/000215356.
Anticoagulation during haemodialysis for chronic renal failure can be assessed by measurement of plasma fibrinopeptide A (FPA) levels as an objective method of monitoring the initial step in fibrin formation, in conjunction with visual inspection of the dialyser circuit for fibrin clot deposition. Employing this approach, unfractionated commercial heparin administered as an intravenous bolus followed by an intravenous maintenance dose (5,000 IU + 1,500 IU/h) was found to suppress almost completely fibrin formation and deposition during prolonged dialysis. Comparison of a low molecular weight heparin, Kabi 2165, revealed that it can inhibit fibrin formation in the extracorporeal circulation, that this property is largely reflected in its anti-factor Xa activity in plasma, and that a useful and effective dose of Kabi 2165 for haemodialysis may be 4,000 anti-factor Xa U intravenous bolus + 750 anti-factor Xa U/h intravenous maintenance infusion. This dose only minimally alters the KCCT and corresponds to approximately 60% of that of unfractionated heparin, which may be important in the long-term use of heparin in these patients.
对于慢性肾衰竭患者进行血液透析时的抗凝作用，可通过测量血浆纤维蛋白肽A（FPA）水平来评估，这是监测纤维蛋白形成初始步骤的一种客观方法，同时结合肉眼观察透析器回路中纤维蛋白凝块的沉积情况。采用这种方法，发现静脉推注普通商用肝素后再给予静脉维持剂量（5000 IU + 1500 IU/h），在长时间透析过程中几乎能完全抑制纤维蛋白的形成和沉积。对低分子量肝素Kabi 2165的比较显示，它能抑制体外循环中的纤维蛋白形成，这种特性在很大程度上反映在其血浆抗Xa因子活性上，且对于血液透析而言，Kabi 2165的有效剂量可能为静脉推注4000抗Xa因子单位 + 静脉维持输注750抗Xa因子单位/小时。该剂量对全血凝固时间（KCCT）的影响极小，相当于普通肝素剂量的约60%，这对于这些患者长期使用肝素可能具有重要意义。
