[Minimal heparinization in dialysis patients with increased risk of bleeding].
In 78 patients (47 men, 31 women; mean age 53 [22-78] years) 174 dialyses were undertaken within one week of a bleeding episode or a diagnostic or therapeutic procedure which may cause bleeding. Minimal anticoagulation with low molecular weight heparin (LMWH) was the aim, using a biocompatible dialyser. During the dialysis coagulation was controlled by global tests (Quick value/international normalized ratio [INR], partial thromboplastin time, thrombin time, antifactor Xa activity), by molecular markers of clotting activity (thrombin-antithrombin III complex [TAT], D-dimers), as well as measurement of elastase (elastase-alpha 1-protein inhibitor complex). The LMWH dosage averaged 932 units as an initial bolus and 234 units/h as a continuous infusion. In the group of chronic dialysis patients (n = 72) this meant (standard heparin units = 2/3 LMWH units) a reduction to 45 +/- 11% from the previously used routine heparin dosage for a 4-hour dialysis. All dialyses were completed without bleeding complications. Considerable clotting formation in the extracorporeal circulation occurred in 11 dialyses (6.3%). TAT, D-dimer and elastase values proved to be suitable for determining individual clotting activity and for reducing anticoagulation to the minimum.
Klingel
R
R
I. Medizinische Klinik und Poliklinik, Universität Mainz.
Wandel
E
E
Hafner
G
G
Meyer zum Büschenfelde
K H
KH
Köhler
H
H
D000328:Adult; D000368:Aged; D001780:Blood Coagulation Tests; D015951:Factor Xa; D005260:Female; D006470:Hemorrhage / Q000517:prevention & control*; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010196:Pancreatic Elastase / Q000097:blood; D010314:Partial Thromboplastin Time; D006435:Renal Dialysis; D013918:Thrombin Time
D006495:Heparin, Low-Molecular-Weight; D010196:Pancreatic Elastase; D015951:Factor Xa
Minimalheparinisierung bei Dialysepatienten mit erhöhter Blutungsgefährdung.