Effective anticoagulation by a low molecular weight heparin (Fragmin) in hemodialysis with a highly permeable polysulfone membrane.
The efficacy and kinetics of a low molecular weight heparin fragment (LMWH-fragment, Fragmin) were studied during one hemodialysis session with a highly permeable polysulfone membrane and compared to a second dialysis session using a conventional cuprophane membrane. All patients received 5000 U of Fragmin given as an injection into the arterial line at start of dialysis. The anticoagulative efficacy was evaluated by measuring plasma fibrinopeptide A concentrations. LMWH-fragment concentrations in plasma and ultrafiltrate were determined by an amidolytic activity assay and by a radioimmunoassay using a monoclonal antibody. During hemodialysis with cuprophane and polysulfone membranes the fibrinopeptide A concentrations were low indicating adequate anticoagulation. LMWH concentrations in plasma did not differ in the two membranes at any time. The LMWH-fragment in the ultrafiltrate could neither be detected with the amidolytic assay nor with the radioimmunoassay. We conclude that a single injection of Fragmin effectively prevents clotting during hemodialysis with a highly polysulfone membrane. No significant amounts of the anticoagulant are lost over the dialysis membrane.
Ljungberg
B
B
Department of Medicine, Karolinska Hospital, Stockholm, Sweden.
Jacobson
S H
SH
Lins
L E
LE
Pejler
G
G
D000368:Aged; D001672:Biocompatible Materials; D002482:Cellulose / Q000031:analogs & derivatives; D005260:Female; D005344:Fibrinopeptide A / Q000032:analysis; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy; D008297:Male; D008567:Membranes, Artificial; D008875:Middle Aged; D011108:Polymers; D006435:Renal Dialysis; D013450:Sulfones
D001672:Biocompatible Materials; D006495:Heparin, Low-Molecular-Weight; D008567:Membranes, Artificial; D011108:Polymers; D013450:Sulfones; C017662:polysulfone P 1700; D005344:Fibrinopeptide A; D002482:Cellulose; C009865:cuprammonium cellulose