Comparison of effects of different heparins on thrombin activatable fibrinolysis inhibitor in hemodialyzed patients.
BACKGROUND
Thrombin activatable fibrinolysis inhibitor (TAFI) is a regulator of endogenous fibrinolysis. Heparin is used routinely during dialysis sessions to prevent clot formation in the extracorporeal circuit; therefore the aim of the study was to assess whether unfractionated heparin or low-molecular-weight heparins affect TAFI concentration and activity in hemodialyzed patients.


METHODS
Dalteparin (n = 16) or enoxaparin (n = 25) were administered before the second hemodialysis session in the week in a single dose, whereas unfractionated heparin (n = 18) was given first as a bolus, then in a pump. We also evaluated thrombin activity (thrombin-antithrombin complexes, prothrombin fragments 1 + 2), TAFI activator, thrombomodulin, a catalyzer of TAFI activation and a marker of endothelial cell injury, and the degree of plasmin generation (plasmin-antiplasmin complexes).


RESULTS
TAFI concentration, activity and markers of ongoing coagulation, i.e. prothrombin fragments 1 + 2 and thrombin-antithrombin complexes, were significantly higher in patients anticoagulated with unfractionated heparin when compared to both enoxaparin and dalteparin groups. Thrombin-antithrombin complexes, plasmin-antiplasmin complexes, prothrombin fragments 1 + 2, and thrombomodulin did not differ between patients anticoagulated with dalteparin and enoxaparin.


CONCLUSIONS
Our results suggest that low-molecular-weight heparins influence TAFI and other hemostatic parameters in hemodialyzed patients to a lesser degree than unfractionated heparin. Increased TAFI is possibly due to thrombin appearance during hemodialysis with unfractionated heparin.
Małyszko
Jolanta
J
Department of Nephrology and Transplantology, Medical University, Białystok, Poland. jolmal@poczta.onet.pl
Małyszko
Jacek S
JS
Hryszko
Tomasz
T
Pawlak
Krystyna
K
Myśliwiec
Michał
M
D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage*; D025901:Carboxypeptidase B2 / Q000378:metabolism*; D017985:Dalteparin / Q000008:administration & dosage*; D017984:Enoxaparin / Q000008:administration & dosage*; D005260:Female; D005341:Fibrinolysin / Q000378:metabolism; D006487:Hemostasis / Q000187:drug effects; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008875:Middle Aged; D010446:Peptide Fragments / Q000378:metabolism; D011498:Protein Precursors / Q000378:metabolism; D011516:Prothrombin / Q000378:metabolism; D006435:Renal Dialysis; D018180:Thrombomodulin / Q000378:metabolism; D013927:Thrombosis / Q000517:prevention & control*
D000925:Anticoagulants; D017984:Enoxaparin; D010446:Peptide Fragments; D011498:Protein Precursors; D018180:Thrombomodulin; C029733:prothrombin fragment 1; D011516:Prothrombin; D025901:Carboxypeptidase B2; D005341:Fibrinolysin; D017985:Dalteparin