title: Local anticoagulation of the extracorporeal circuit with heparin and subsequent neutralization with protamine during immunoadsorption.
abstract: A regimen of local anticoagulation of an immunoadsorption device was studied. The extracorporeal circuit was anticoagulated with citrate (5.5%) and a continuous infusion of heparin (2,000 U/h or 1,500 U/h), which was neutralized by a continuous infusion of protamine chloride (75% of the heparin dose) before reinfusion in 23 patients treated with low-density lipoprotein or immunoglobulin apheresis. Sufficient anticoagulation of the extracorporeal circuit was obtained (activated partial thromboplastin time [APTT] > 180 seconds; thrombin time [TT] > 120 seconds; anti-Xa activity, 1.05 +/- 0.21 U/mL) during the entire treatment of 190 minutes, whereas coagulation parameters in the patients' blood stayed within the normal range. In a control group without heparin neutralization, full systemic anticoagulation of the patients occurred (APTT, 157.8 +/- 30.6 seconds; TT, 119.8 +/- 0.4 seconds; anti-Xa activity, 0.88 +/- 0.21 U/mL). No side effects or clotting of the system were observed. Our data show that this regimen of local anticoagulation is a safe protocol for extracorporeal circulation without exposing the patients to anticoagulants.
authors.affiliation: Department of Medicine III, Division of Nephrology and Dialysis, University of Vienna, Austria. sabine@nephro.imed3.akh-wien.ac.at
authors.forename: S
authors.initials: S
authors.lastname: Schmaldienst
authors.forename: A
authors.initials: A
authors.lastname: Goldammer
authors.forename: S
authors.initials: S
authors.lastname: Spitzauer
authors.forename: K
authors.initials: K
authors.lastname: Derfler
authors.forename: W H
authors.initials: WH
authors.lastname: Hörl
authors.forename: P
authors.initials: P
authors.lastname: Knöbl
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000494:pharmacology*; D001777:Blood Coagulation / Q000187:drug effects*; D001781:Blood Component Removal / Q000295:instrumentation* / Q000379:methods; D002125:Calcium Gluconate / Q000008:administration & dosage; D016022:Case-Control Studies; D005112:Extracorporeal Circulation / Q000295:instrumentation*; D005260:Female; D006801:Humans; D006937:Hypercholesterolemia / Q000097:blood / Q000628:therapy*; D007154:Immune System Diseases / Q000097:blood / Q000628:therapy*; D007163:Immunosorbent Techniques / Q000295:instrumentation*; D008077:Lipoproteins, LDL / Q000097:blood; D008297:Male; D010314:Partial Thromboplastin Time; D011446:Prospective Studies; D011479:Protamines / Q000008:administration & dosage; D013918:Thrombin Time
chemical_list: D000925:Anticoagulants; D008077:Lipoproteins, LDL; D011479:Protamines; D002125:Calcium Gluconate