Lorenzini J L, Dutrillaux F, Mousson C, Lassale B, Maynadié M, Rifle G
Laboratoire d'Hématologie, CHU Hôpital du Bocage, Université de Bourgogne, Dijon, France.
J Clin Apher. 1993;8(3):141-6. doi: 10.1002/jca.2920080302.
Treatment by low density lipoprotein (LDL) apheresis using dextran sulfate columns (DSC) leads to hemostasis alterations with prolonged activated partial thromboplastin time (APTT) of more than 120 seconds. In order to explain this hypocoagulability, we studied hemostasis parameters both in patients and in the extracorporeal circulation (ECC). Hemostasis changes are first related to unfractionated heparin (UFH)--needed to avoid circuit coagulation--which leads to high residual heparinemia in the patient (more than 3 times the recommended level for therapeutic use). Second, the hypocoagulability is induced by a coagulation factor decrease (primarily factors V, VIII, and X) mainly due to an adsorption mechanism on dextran sulfate. Studies on samples from column inflow, outflow, and eluate confirm this mechanism. Low molecular weight heparin (LMWH) can be used in LDL apheresis on DSC without major changes in lipid removal or coagulation factors compared to UFH. The benefit of using LMWH is to reduce residual heparinemia into the therapeutic range.
使用硫酸葡聚糖柱（DSC）进行低密度脂蛋白（LDL）单采术治疗会导致止血功能改变，活化部分凝血活酶时间（APTT）延长超过120秒。为了解释这种低凝状态，我们对患者及体外循环（ECC）中的止血参数进行了研究。止血变化首先与普通肝素（UFH）有关——这是避免体外循环回路凝血所必需的——它会导致患者体内肝素残留量过高（超过治疗使用推荐水平的3倍）。其次，低凝状态是由凝血因子减少（主要是因子V、VIII和X）引起的，这主要是由于硫酸葡聚糖的吸附机制。对柱流入、流出和洗脱液样本的研究证实了这一机制。与UFH相比，低分子量肝素（LMWH）可用于DSC上的LDL单采术，而脂质清除或凝血因子无重大变化。使用LMWH的好处是将残留肝素血症降低到治疗范围内。
