Selection of anticoagulants for leukocytapheresis therapy in cases of active ulcerative colitis.
OBJECTIVE
Leukocytapheresis (LCAP) is an extracorporeal leukocyte removal therapy that removes immunocompetent leukocytes from the peripheral blood. Nafamostat mesilate (NM) is the most commonly used anticoagulant for LCAP due to various benefits associated with its use, such as a reduced likelihood of bleeding and minimization of adverse reactions caused by contact between blood and the LCAP device. However, adverse reactions have also been reported with NM administration. We reviewed the safety of anticoagulants other than NM, from the perspective of bradykinin production and the consequent drop in blood pressure during treatment.


METHODS
For each of 10 patients with ulcerative colitis, we used four types of anticoagulants sequentially [NM (30-50 mg), heparin, low-molecular-weight heparin (LMWH) and NM (1 mg), and LMWH] for LCAP. We then examined the changes in the blood bradykinin concentrations from the perspective of adverse reactions during LCAP.


RESULTS
The bradykinin production levels from Cellsorba EX varied, depending on the type of anticoagulant used. NM alone (30-50 mg) or LMWH + NM (1 mg) inhibited bradykinin production, whereas heparin alone or LMWH alone significantly accelerated it. However, an excessive fall of blood pressure was not noted in any of the cases. Use of LMWH alone was frequently associated with pressure elevations in the column.


CONCLUSIONS
Given the significant benefits of minimized adverse reactions of LCAP and of continuation of LCAP, we suggest that an appropriate selection of the anticoagulant(s) may allow safer execution of LCAP.
Kanke
Kazunari
K
Department of Gastroenterology, DOKKYO Medical University, Mibu, Japan. kzkannke@dokkyomed.ac.jp
Hoshino
Mina
M
Tominaga
Keiichi
K
Nakano
Michiko
M
Terano
Akira
A
Hiraishi
Hideyuki
H
D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects*; D001550:Benzamidines; D001672:Biocompatible Materials / Q000009:adverse effects; D015415:Biomarkers; D001920:Bradykinin / Q000097:blood*; D003093:Colitis, Ulcerative / Q000628:therapy*; D018592:Cross-Over Studies; D005374:Filtration / Q000295:instrumentation; D005483:Flushing / Q000139:chemically induced; D006146:Guanidines / Q000008:administration & dosage / Q000009:adverse effects*; D006493:Heparin / Q000008:administration & dosage / Q000009:adverse effects*; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D007022:Hypotension / Q000097:blood / Q000139:chemically induced* / Q000517:prevention & control; D007937:Leukapheresis / Q000295:instrumentation / Q000379:methods*; D047589:Leukocyte Reduction Procedures / Q000295:instrumentation / Q000379:methods*; D009325:Nausea / Q000139:chemically induced; D011091:Polyesters / Q000009:adverse effects; D014520:Urethane / Q000009:adverse effects