Harenberg J, Haaf B, Dempfle C E, Stehle G, Heene D L
1st Department of Medicine, Faculty of Clinical Medicine Mannheim, University of Heidelberg, Germany.
Nephrol Dial Transplant. 1995;10(2):217-22.
In haemodialysis low-molecular-weight (LMW) heparin is increasingly used for anticoagulation. The advantages over unfractionated (UF) heparin are the lower bleeding risk and the lack of influence on lipid metabolism. However, no reliable and rapid method is available so far to control the efficacy and safety of LMW heparin during haemodialysis. The specific anti-factor Xa (aXa) chromogenic substrate assays are laborious and time consuming. In the present study we have compared chromogenic assay with a coagulation assay (heptest), which was performed from plasma and whole-blood samples. The effects were compared with unfractionated heparin during haemodialysis. The aXa activity in the chromogenic S2222 assay ranged between 0.2 and 0.5 U/ml with UF heparin and between 0.4 and 0.8 U/ml with LMW heparin during haemodialysis. The coagulometric aXa activity in heptest assay from plasma was 0.6-1.0 U/ml with UF heparin and 1.2-2.0 U/ml with LMW heparin. The Heptest coagulation values from citrated whole blood samples ranged from 0.4 to 0.8 U/ml with UF heparin and from 0.8 to 1.4 U/ml with LMW heparin. The prolongation of the heptest clotting times with UF and LMW heparin was in the range of 4.4 for UF heparin and 5.2 for LMW heparin using the whole-blood assay. Heptest assay from plasma samples yielded prolongations of 6.1 with UF heparin and 6.6 with LMW heparin. The data show that the coagulation assay is rapid and reproducible using plasma or uncentrifuged whole-blood samples and is valid to monitor UF heparin or LMW heparin in patients undergoing chronic intermittent haemodialysis.
在血液透析中，低分子量（LMW）肝素越来越多地用于抗凝。与普通肝素（UF）相比，其优势在于出血风险较低且对脂质代谢无影响。然而，目前尚无可靠且快速的方法来控制血液透析期间LMW肝素的疗效和安全性。特定的抗Xa因子（aXa）显色底物测定法既费力又耗时。在本研究中，我们将显色测定法与一种凝血测定法（七因子试验）进行了比较，后者是从血浆和全血样本中进行的。将这些结果与血液透析期间的普通肝素进行了比较。在血液透析期间，显色S2222测定法中UF肝素的aXa活性范围为0.2至0.5 U/ml，LMW肝素的aXa活性范围为0.4至0.8 U/ml。血浆七因子试验中的凝血aXa活性，UF肝素为0.6 - 1.0 U/ml，LMW肝素为1.2 - 2.0 U/ml。枸橼酸化全血样本的七因子试验凝血值，UF肝素为0.4至0.8 U/ml，LMW肝素为0.8至1.4 U/ml。使用全血测定法时，UF肝素和LMW肝素使七因子试验凝血时间延长，UF肝素为4.4，LMW肝素为5.2。血浆样本的七因子试验中，UF肝素使凝血时间延长6.1，LMW肝素使凝血时间延长6.6。数据表明，使用血浆或未离心的全血样本进行凝血测定法快速且可重复，对于监测接受慢性间歇性血液透析患者的UF肝素或LMW肝素是有效的。
