title: The control of anti-coagulation in acute dialyses with sensitive laboratory parameters.
abstract: In seven patients who had to be dialysed between four and 13 times due to acute renal failure, low molecular weight heparin (LMWH) Fragmin was used for anticoagulation. According to dose-finding studies, 80-90 U kg-1 body weight of LMWH as a single bolus were administered initially, producing dose-related levels of 0.3-1.5 anti-factor Xa U ml-1 in plasma. Apart from the anti-Xa activity in the plasma, the thrombin anti-thrombin III complex (TAT complex) and a fibrin degradation product (D-dimer) were measured as parameters of a coagulation activation. A sufficient anti-coagulation during dialysis was supposed to exist at a normal range (5.0 micrograms l-1 or below) of TAT complex. Pathological TAT concentrations at the end of dialysis indicated the requirement of an increased dose for the next dialysis. These concentrations reflected a need for more heparin if, for example, inflammation, indicated by increasing C-reactive protein levels (CRP), occurred. The increase of TAT complex and D-dimer during dialysis showed a good agreement (p less than 0.001). Due to a single bolus application before dialysis, one measurement of TAT at the end of the dialysis was sufficient. The determination of the TAT complex concentration enabled a heparinization better adapted to the clinical situation of intensive-care patients undergoing acute dialyses, so that the coagulation system was not additionally activated by the extracorporeal circulation.
authors.affiliation: Institute of Clinical Chemistry, Johannes Gutenberg University, Mainz, Germany.
authors.forename: G
authors.initials: G
authors.lastname: Hafner
authors.forename: H
authors.initials: H
authors.lastname: Swars
authors.forename: W
authors.initials: W
authors.lastname: Ehrenthal
authors.forename: H
authors.initials: H
authors.lastname: Schinzel
authors.forename: L S
authors.initials: LS
authors.lastname: Weilemann
authors.forename: W
authors.initials: W
authors.lastname: Prellwitz
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood / Q000628:therapy*; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage*; D000990:Antithrombin III / Q000378:metabolism; D001777:Blood Coagulation / Q000187:drug effects; D065427:Factor Xa Inhibitors; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008875:Middle Aged; D010447:Peptide Hydrolases / Q000378:metabolism; D006435:Renal Dialysis / Q000009:adverse effects / Q000379:methods*
chemical_list: D000925:Anticoagulants; D065427:Factor Xa Inhibitors; D005338:Fibrin Fibrinogen Degradation Products; D006495:Heparin, Low-Molecular-Weight; C046193:antithrombin III-protease complex; C036309:fibrin fragment D; D000990:Antithrombin III; D010447:Peptide Hydrolases