TICLOPIDINE IMPROVES DIALYSIS CLEARANCE OF SOLUTES IN UREMIC PATIENTSBY REDUCING BLOOD-CLOTTING IN DIALYZER FIBERS

Ticlopidine, a platelet aggregation inhibitor was tested, in a double blind comparative cross-over study versus placebo, in 51 dialysed urem ic patients who had increased dialyser blood clotting (> 25 fibers clo tted / dialyser). At the end of a 7-day treatment period with 250 mg d aily, the clearance of urea, creatinine and phosphate was determined a t 30 and 210 minutes of dialysis, as well as the number of fibers clot ted at the end of dialysis. Ticlopidine improved dialyser clearances f or urea, creatinine and phosphate from 165 +/- 41 to 182 +/- 35 (p < 0 .01), 135 +/- 37 to 143 +/- 35 (p < 0.05), and 120 +/- 36 to 130 +/- 3 5 (p < 0.05) ml/min, respectively, at 30 min of HD and a similar effec t was seen after 210 min of dialysis. The number of dialyser fibers cl otted after dialysis was reduced by ticlopidine therapy from 110 +/- 4 8 to 15 +/- 8 (p < 0.01). Ticlopidine reduced the initial dialysis-ind uced drop in leucocyte count by 20% (p < 0.05); no change in platelet or erythrocyte count was observed. Two out of 51 patients experienced an adverse reaction from ticlopidine (cutaneous haematoma and minor gi ngival bleeding). We conclude that ticlopidine is an efficient and saf e drug for dialysed uremic patients since it can reduce blood clotting and thereby increase dialysis efficiency.