Casati S, Moia M, Graziani G, Cantaluppi A, Citterio A, Mannucci P M, Ponticelli C
Clin Nephrol. 1984 Feb;21(2):102-5.
In 29 patients with high risk of bleeding, 111 hemodialyses have been performed without heparin (WHD) or other anticoagulants. The same patients were switched to low dose heparin dialysis (LDHD) as soon as the bleeding risk had ceased. The dialyzer had to be changed in 11 and the drip chamber in 20 WHDs because of partial clotting. This phenomenon did not occur during LDHD. The comparative efficiencies of the two techniques were evaluated by measuring the urea and creatinine clearances of the dialyzers. No significant difference between LDHD and WHD clearances was observed. In 7 of 29 patients, hemostasis variables were studied before, during and after both modes of treatment. Fibrinogen, platelet count, antithrombin III and prothrombin time did not differ with the different dialysis procedures. During dialysis, platelet factor 4 (PF4) levels were significantly higher than baseline values (P less than 0.01), with no difference between WHD and LDHD. Plasma fibrinopeptide A (FPA) levels remained normal during LDHD, but significantly increased during WHD (P less than 0.001). Our data indicate that WHD is feasible, with a low risk of extravascular coagulation. The bleeding risk is not increased during or after dialysis, and the danger of intravascular coagulation is low as confirmed by the isolated elevation of FPA plasma levels, unaccompanied by changes in other variables.
在29例出血风险较高的患者中，已进行了111次无肝素（WHD）或其他抗凝剂的血液透析。一旦出血风险消失，这些患者就转为低剂量肝素透析（LDHD）。由于部分凝血，在11次WHD中需要更换透析器，20次WHD中需要更换滴壶。这种现象在LDHD期间未发生。通过测量透析器的尿素和肌酐清除率来评估这两种技术的相对效率。未观察到LDHD和WHD清除率之间的显著差异。在29例患者中的7例中，研究了两种治疗模式之前、期间和之后的止血变量。纤维蛋白原、血小板计数、抗凝血酶III和凝血酶原时间在不同的透析程序中没有差异。透析期间，血小板因子4（PF4）水平显著高于基线值（P<0.01），WHD和LDHD之间没有差异。在LDHD期间，血浆纤维肽A（FPA）水平保持正常，但在WHD期间显著升高（P<0.001）。我们的数据表明，WHD是可行的，血管外凝血风险较低。透析期间或之后出血风险没有增加，并且如FPA血浆水平单独升高所证实的那样，血管内凝血的风险较低，且其他变量没有变化。
