Lai Qiquan, Chen Ling, Gao Xuejing, Tie Hongtao, Wan Ziming
Department of Nephrology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Department of Cardiothoracic Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Front Cardiovasc Med. 2025 Mar 24;12:1561645. doi: 10.3389/fcvm.2025.1561645. eCollection 2025.
Type A aortic dissection (AD) is a lethal situation with high mortality within short time after onset. We present here a rare hemodialysis patient whose condition was comorbid with unrepaired type A AD. The challenge we face is whether low-molecular-weight heparin (LMWH) should be used during dialysis.
A 72-year-old man with a history of hemodialysis for 2 years and 7 months sought medical attention due to thrombosis of the dialysis catheter. He had been diagnosed with an unrepaired type A aortic dissection (involving the aortic root, the ascending aorta, the aortic arch, the descending aorta, the abdominal aorta, the left common iliac artery, and the femoral artery) for more than 5 years. LMWH was not given during the previous dialysis process because of concerns about the rupture of the dissection. The lesion was salvaged via urokinase thrombolysis. However, the anticoagulant-free dialysis pattern occasionally caused dialyzer clotting and further increased the risk of catheter dysfunction. The patient repeatedly experienced dysfunction of the catheter in the following 8 months, with 2 episodes resolved via thrombolysis and 2 episodes replaced with new catheters. Finally, LMWH was used for each dialysis session to prevent thrombosis, with the dosage gradually increasing from 1,000 units to 2,000 units. The dosage of 2,000 units could support sufficient 4-hour dialysis for each session. Twenty-five months have passed since then, the patient has not experienced any further occlusion of the catheter, and the aortic dissection has not shown obvious changes (neither obvious expansion nor rupture).
Reducing the dosage of LMWH during hemodialysis is a feasible solution to maintain a balance between hemodialysis access patency and stable dissection status in this particular patient.
A型主动脉夹层（AD）是一种致命疾病，发病后短时间内死亡率很高。我们在此介绍一位罕见的血液透析患者，其病情合并未修复的A型AD。我们面临的挑战是在透析期间是否应使用低分子量肝素（LMWH）。
一名72岁男性，有2年7个月的血液透析病史，因透析导管血栓形成前来就医。他被诊断为未修复的A型主动脉夹层（累及主动脉根部、升主动脉、主动脉弓、降主动脉、腹主动脉、左髂总动脉和股动脉）已超过5年。由于担心夹层破裂，之前的透析过程中未给予LMWH。通过尿激酶溶栓挽救了病变。然而，无抗凝剂的透析模式偶尔会导致透析器凝血，并进一步增加导管功能障碍的风险。在接下来的8个月里，患者反复出现导管功能障碍，2次发作通过溶栓解决，2次发作更换了新导管。最后，每次透析均使用LMWH以预防血栓形成，剂量从1000单位逐渐增加到2000单位。2000单位的剂量足以支持每次4小时的透析。自那时起已过去25个月，患者未再出现导管堵塞，主动脉夹层也未出现明显变化（既无明显扩张也无破裂）。
对于该特殊患者，在血液透析期间减少LMWH剂量是在维持血液透析通路通畅与稳定夹层状态之间取得平衡的可行解决方案。
