Ward R A, Schmidt B, Gurland H J
Division of Nephrology, School of Medicine, University of Louisville, Kentucky 40292.
Nephrol Dial Transplant. 1993;8(10):1140-5.
Binding of heparin to DEAE-cellulose membranes may reduce bioavailable heparin, thus increasing the amount of heparin needed for anticoagulation during dialysis. To test this hypothesis, blood loss and coagulation were evaluated during dialysis with DEAE-cellulose and polysulphone membranes. The heparin dose required to effect a given increase in the baseline recalcified activated clotting time (RACT) was determined using a pharmacokinetic model. Blood remaining in the dialyser post-dialysis (RBV) was measured by red cell lysis and haemoglobinometry. Plasma thrombin-antithrombin III complex (TAT) was used to assess activation of the coagulation system. RBV and changes in TAT were determined in two crossover studies. Firstly, DEAE-cellulose membranes were used at doses of heparin calculated to increase baseline RACT by 12.5% and 25%. Secondly, DEAE-cellulose and polysulphone membranes were compared at a heparin dose calculated to increase baseline RACT by 15%. RBV for DEAE-cellulose membranes was independent of the dose of heparin and did not differ from that found for polysulphone membranes. TAT concentrations increased during dialysis; however, there was no difference between the two membranes. These results show that DEAE-cellulose membranes do not require increased heparin to avoid dialyser-associated blood loss.
肝素与二乙氨基乙基纤维素（DEAE - 纤维素）膜的结合可能会减少可生物利用的肝素，从而增加透析期间抗凝所需的肝素量。为了验证这一假设，在使用DEAE - 纤维素膜和聚砜膜进行透析期间评估了失血和凝血情况。使用药代动力学模型确定实现基线复钙活化凝血时间（RACT）给定增加所需的肝素剂量。透析后留在透析器中的血液（RBV）通过红细胞裂解和血红蛋白测定法进行测量。血浆凝血酶 - 抗凝血酶III复合物（TAT）用于评估凝血系统的激活情况。在两项交叉研究中确定了RBV和TAT的变化。首先，使用DEAE - 纤维素膜，肝素剂量按计算可使基线RACT增加12.5%和25%。其次，在肝素剂量按计算可使基线RACT增加15%的情况下，比较了DEAE - 纤维素膜和聚砜膜。DEAE - 纤维素膜的RBV与肝素剂量无关，且与聚砜膜的RBV无差异。透析期间TAT浓度升高；然而，两种膜之间没有差异。这些结果表明，DEAE - 纤维素膜不需要增加肝素用量来避免与透析器相关的失血。
