Intraperitoneal heparin in peritoneal dialysis and its effect on fibrinopeptide A in plasma and dialysate.
In 6 patients on continuous ambulatory peritoneal dialysis we investigated the inhibition of intraperitoneal fibrin formation by heparin. A continuous addition of 500 U of heparin per liter dialysate was used for 52 h. In plasma no heparin activity could be detected, even 52 h after intraperitoneal administration of heparin. The fibrin formation was determined by fibrinopeptide A, a thrombin-induced split product of fibrinogen. In patients under regular continuous ambulatory peritoneal dialysis we determined the fibrinopeptide A concentrations in plasma. The values were comparable with the fibrinopeptide A concentrations measured in disseminated intravascular coagulopathy. They decreased during intraperitoneal administration of heparin from 63.2 +/- 11.8 to 4.9 +/- 1.7 ng/ml. The fibrinopeptide A concentration in the 4-hour intraperitoneal dialysate (155.8 +/- 15.7 ng/ml) decreased after heparin administration to 8.5 +/- 2.0 ng/ml and was always higher than in plasma. We conclude that 500 U heparin per liter dialysate prevents the intraperitoneal fibrin formation. The low antithrombin III concentration (0.44 +/- 0.13 mg/dl) in protein-poor dialysate seems to be sufficient to inhibit the thrombin activity after acceleration by heparin.
Gries
E
E
Department of Medicine, University of Essen, FRG.
Paar
D
D
Graben
N
N
Bock
K D
KD
D001202:Ascitic Fluid; D003928:Diabetic Nephropathies / Q000097:blood / Q000628:therapy; D005260:Female; D005340:Fibrinogen / Q000032:analysis*; D005344:Fibrinopeptide A / Q000032:analysis*; D006493:Heparin / Q000008:administration & dosage*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000628:therapy; D008297:Male; D010531:Peritoneal Dialysis, Continuous Ambulatory; D012996:Solutions / Q000032:analysis
D012996:Solutions; D005344:Fibrinopeptide A; D005340:Fibrinogen; D006493:Heparin