MINIMAL HEPARINIZATION IN DIALYSIS PATIEN TS AT INCREASED RISK OF BLEEDING

In 78 patients (47 men. 31 women; mean age 53 [22-78] years) 174 dialy ses; wore undertaken within one week of a bleeding episode or a diagno stic or therapeutic procedure which may cause bleeding. Minimal antico agulation with low molecular weight heparin (LMWH) was the aim, using a biocompatible dialyser. During the dialysis coagulation was controll ed by global tests (Quick value/international normalized ratio [INR], partial thromboplastin time, thrombin time, anti-factor Xa activity), by molecular markers of clotting activity (thrombin-antithrombin III c omplex [TAT], D-dimers), as well as measurement of elastase (elastase- alpha1-protein inhibitor complex). The LMWH dosage averaged 932 units as an initial bolus and 234 units/h as a continuous infusion. In the g roup of chronic dialysis patients (n = 72) this meant (standard hepari n units = 2/3 LMWH units) a reduction to 45 +/- 11 % from the previous ly used routine heparin dosage for a 4-hour dialysis. All dialyses wer e completed without bleeding complications. Considerable clotting form ation in the extracorporeal circulation occurred in 11 dialyses (6.3 % ). TAT, D-dimer and elastase values proved to be suitable for determin ing individual clotting activity and for reducing anticoagulation to t he minimum.