Intraindividual comparison of the impact of two selective apheresis methods (DALI and HELP) on the coagulation system

We performed an intraindividual comparison of the effect on the coagulation system of two selective apheresis procedures. Direct Adsorption of Lipopro teins (DALI) and Heparin-induced Lipoprotein Fibrinogen Precipitation (HELP ). Six patients suffering from heterozygous familial hypercholesterolemia h ave been treated with 2 sessions of each procedure. Anticoagulation was car ried out according to usual recommendations. Blood samples were taken befor e, immediately after and on the second day after the sessions. We assessed global coagulation tests (prothrombin time, activated partial thromboplasti n time), fibrinogen, prothrombin fragment F 1 + 2 and a variety of factors (Factors II, V, VII, XIII, IX, X, XI, XII, XIIa; von Willebrand Factor; col lagen-binding activity prekallikrein, high-molecular weight kininogen) and antagonists (antithrombin III, protein S activity free protein S). In fact, all parameters measured have been influenced by the apheresis treatment. F ibrinogen is lowered more by HELP, which also has a more definite impact on factors belonging to the prothrombin complex (II, VII, X). in contrast, th e major effects of the DALI system have been seen on the intrinsic pathway of the coagulation system (IX, XI, prekallikrein, high-molecular-weight kin inogen). With both systems no increases in activated Factor XII or in proth rombin fragment F1 + 2 have been observed These data provide a solid basis for individual adaptations of anticoagulant doses.