ENHANCED BLOOD-COAGULATION AND ENHANCED FIBRINOLYSIS DURING HEMODIALYSIS WITH PROSTACYCLIN

In the present study the effect of unfractionated heparin (UFH) (Lique min (R), 750-1000 IU/h), low molecular weight heparin (LMWH) (Fragmin (R), 3000-7250 IU bolus), and prostacyclin (Flolan (R), 5 ng/kg body w eight/min) on the activation of blood coagulation and fibrinolysis, in duced by polysulfone membrane dialyzers during hemodialysis, was compa red. Plasma levels of thrombin-antithrombin III complex (TAT), fibrin split product D-dimer, and plasmin-plasmin inhibitor-complex (PPI) wer e measured in the arterial and venous line of the dialyzer at the begi nning and at 10, 60, 120, and 180 minutes of hemodialysis. Five patien ts on chronic hemodialysis treatment were investigated in a cross over study. Clinically all three anticoagulation regimen were sufficient f or hemodialysis treatment. Using UFH or LMWH TAT, PPI, and D-dimer lev els were similar in the venous and the arterial line of the dialyzer. However, during prostacyclin treatment the levels of these activation markers were significantly higher in the venous line. Based on these d ata the dialyzer membrane can be considered as a site of activation of blood coagulation and of fibrinolysis during anticoagulation with pro stacyclin in hemodialysis. (C) 1998 Elsevier Science Ltd.