Local anticoagulation of the extracorporeal circuit with heparin and subsequent neutralization with protamine during immunoadsorption

A regimen of local anticoagulation of an immunoadsorption device was studie d. The extracorporeal circuit was anticoagulated with citrate (5.5%) and a continuous infusion of heparin (2,000 U/h or 1,500 U/h), which was neutrali zed by a continuous infusion of protamine chloride (75% of the heparin dose ) before reinfusion in 23 patients treated with low-density lipoprotein or immunoglobulin apheresis. Sufficient anticoagulation of the extracorporeal circuit was obtained (activated partial thromboplastin time [APTT] > 180 se conds; thrombin time [TT] > 120 seconds; anti-Xa activity, 1.05 +/- 0.21 U/ mL) during the entire treatment of 190 minutes, whereas coagulation paramet ers in the patients' blood stayed within the normal range. In a control gro up without heparin neutralization, full systemic anticoagulation of the pat ients occurred (APTT, 157.8 +/- 30.6 seconds; TT, 119.8 +/- 0.4 seconds; an ti-Xa activity, 0.88 +/- 0.21 U/mL). No side effects or clotting of the sys tem were observed. Our data show that this regimen of local anticoagulation is a safe protocol for extracorporeal circulation without exposing the pat ients to anticoagulants, (C) 2000 by the National Kidney Foundation, Inc.