title: Platelet-related hemostasis before and after hemodialysis with five different anticoagulation methods.
abstract: OBJECTIVE
  To evaluate platelet-related hemostasis during hemodialysis performed with five different anticoagulation methods.
  
  
  METHODS
  31 chronic hemodialysis patients, 71% men, aged 57.5 ± 17.4 years, participated in our prospective study. Platelet function analyzer PFA -100 closure time (collagen/epinephrine -CEPI, collagen/adenosine diphosphate -CADP) was measured before and after hemodialysis, which was performed consecutively with five different anticoagulation methods: full-dose unfractionated heparin (UFH) and low-molecular weight heparin (LMWH): 31 patients, regional citrate anticoagulation (RCA): 28 patients, low-dose heparin: 25 patients and "heparin-free'' dialysis: 9 patients. The degree of clotting in the dialysis system was graded on a 5 point scale.
  
  
  RESULTS
  CEPI (mean ± SD, reference range 80-160 sec) before vs. after hemodialysis: UFH: 171.7 ± 62.1 vs. 170.8 ± 67.3; LMWH: 167.4 ± 56.9 vs. 159.4 ± 56.4; low-dose heparin: 175.3 ± 69.0 vs. 183.1 ±  60.5; RCA: 172.6 ± 57.4 vs. 161.6 ± 57.0; "heparin-free'': 181.7 ± 56.8 vs. 209.0 ± 66.5; all differences nonsignificant. CADP (mean ± SD, reference range: 68-121 sec) before vs. after hemodialysis: UFH: 132.0 ± 56.6 vs.146.3 ± 68.4; LMWH: 132.4 ± 57,0 vs. 123.1 ± 50.8; low-dose heparin: 137.2 ± 64.2 vs. 143.8 ± 55.5; RCA: 140.7 ± 48.2 vs. 132.9 ± 48.1; "heparin-free'': 137.1 ± 68.0 vs.139.2 ± 29.7; all differences nonsignificant. Before hemodialysis procedure CEPI was increased in 51.2% and CADP in 48.4% of the patients. The best dialysis system clotting score was found with UFH, LMWH and RCA.
  
  
  CONCLUSIONS
  Platelet dysfunction was demonstrated in approximately half of the chronic hemodialysis patients and was not improved after hemodialysis, regardless of the anticoagulation regimen used.
authors.affiliation: Department of Nephrology, University Medical Centre Ljubljana, Ljubljana, Slovenia.
authors.forename: Masa
authors.initials: M
authors.lastname: Knehtl
authors.forename: Rafael
authors.initials: R
authors.lastname: Ponikvar
authors.forename: Jadranka
authors.initials: J
authors.lastname: Buturovic-Ponikvar
mesh_terms: D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000494:pharmacology*; D001777:Blood Coagulation / Q000187:drug effects*; D001792:Blood Platelets / Q000187:drug effects*; D005260:Female; D006487:Hemostasis / Q000187:drug effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000379:methods*; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000628:therapy
chemical_list: D000925:Anticoagulants