Gross M L, Bush H, Weinger R, Hamburger R J, Flamenbaum W
J Lab Clin Med. 1982 Dec;100(6):887-95.
The efficacies of low-dose heparin and low-dose heparin plus ticlopidine as anticoagulants during hemodialysis in acutely uremic dogs were compared and evaluated. Heparin was administered as a bolus at a dose of 100 U/kg. In preliminary experiments it was determined that dogs dialyzed with ticlopidine alone demonstrated gross clotting of the artificial kidney within 2.5 hr. Ticlopidine was administered by gavage at a dose of 50 mg/kg/day starting 72 hr prior to hemodialysis and continuing throughout the period of hemodialysis (4 days). Each dog was dialyzed four times with either heparin alone or heparin plus ticlopidine. Each hemodialysis lasted 3.5 hr. Parameters followed included dialysis clearance of urea and creatinine, ultrafiltration rate, residual blood volume, gross clotting episodes, platelet count, and levels of fibrinogen and thromboxane B2. A lesser degree of hemodialysis-associated thrombocytopenia, a lower residual blood volume, fewer episodes of gross clotting, no reduction in fibrinogen levels, and no increase in thromboxane B2 levels were observed in the heparin plus ticlopidine group as compared to the heparin group alone. Although ticlopidine at the dosage employed should not be used as the sole anticoagulant for hemodialysis, it may be useful when added to low-dose heparin. The salutary effects demonstrated in this study suggest clinical benefits of the combination.
比较并评估了低剂量肝素和低剂量肝素加噻氯匹定在急性尿毒症犬血液透析期间作为抗凝剂的疗效。肝素以100 U/kg的剂量静脉推注给药。在初步实验中确定，单独用噻氯匹定透析的犬在2.5小时内人工肾出现严重凝血。在血液透析前72小时开始，以50 mg/kg/天的剂量经口灌胃给予噻氯匹定，并在整个血液透析期间（4天）持续给药。每只犬分别单独使用肝素或肝素加噻氯匹定进行4次血液透析。每次血液透析持续3.5小时。监测的参数包括尿素和肌酐的透析清除率、超滤率、残余血量、严重凝血事件、血小板计数以及纤维蛋白原和血栓素B2水平。与单独使用肝素组相比，肝素加噻氯匹定组观察到血液透析相关血小板减少程度较轻、残余血量较低、严重凝血事件较少、纤维蛋白原水平无降低且血栓素B2水平无升高。尽管所用剂量的噻氯匹定不应作为血液透析的唯一抗凝剂，但添加到低剂量肝素中可能有用。本研究中显示的有益效果提示了这种联合用药的临床益处。
