Vukusich A, Avalos C, Orellana G, Cifuentes C, Rivas J, Calderón F
Unidad de Nefrología, Clínica Dávila, Santiago de Chile.
Rev Med Chil. 1995 Jun;123(6):735-41.
The aim of this work was to compare the benefits and problems of low molecular weight heparin use in chronic hemodialysis, compared to conventional heparin. We studied 35 patients that received low molecular weight heparin (Enoxaparine, molecular weight 4000) during 115 consecutive hemodialysis procedures and conventional heparin during the subsequent 35 procedures. We assess the heparin dose, partial thromboplastin time before dialysis and at 3 and 120 min during the procedure, arterio-venous fistula compression time, clot formation in the circuit and residual volume of filters. Median total dose of conventional heparin was 6289 U (range 3000-10000) compared to 5555 U (range 2000-8000) of low molecular weight heparin. When the dose was calculated per kg of body weight, it was lower for low molecular weight heparin than for conventional heparin (87.8 U (range 33-100) vs 100 U (range 50-176)). Partial thromboplastin time achieved was lower with low molecular weight heparin, compared with conventional heparin, at 3 (64.26 vs 125.2 sec) and 120 min (39.1 vs 84.45 sec). Clot formation, arteriovenous fistula compression time and residual volume of filters were similar for both types of heparin. It is concluded that a single dose of low molecular weight heparin simplifies anticoagulation during hemodialysis, modifies less the partial thromboplastin time and does not alter filter re-utilization.
本研究的目的是比较低分子量肝素与传统肝素在慢性血液透析中的利弊。我们研究了35例患者，他们在115次连续血液透析过程中接受低分子量肝素（依诺肝素，分子量4000），随后的35次过程中接受传统肝素。我们评估了肝素剂量、透析前及透析过程中3分钟和120分钟时的部分凝血活酶时间、动静脉内瘘压迫时间、体外循环中的凝血形成以及滤器残余容积。传统肝素的中位总剂量为6289 U（范围3000 - 10000），而低分子量肝素为5555 U（范围2000 - 8000）。按体重计算剂量时，低分子量肝素低于传统肝素（87.8 U（范围33 - 100）对100 U（范围50 - 176））。与传统肝素相比，低分子量肝素在3分钟（64.26对125.2秒）和120分钟（39.1对84.45秒）时达到的部分凝血活酶时间更低。两种肝素在凝血形成、动静脉内瘘压迫时间和滤器残余容积方面相似。结论是，单次剂量的低分子量肝素简化了血液透析期间的抗凝过程，较少改变部分凝血活酶时间，并且不影响滤器的重复使用。
