S. Schmaldienst et al., Local anticoagulation of the extracorporeal circuit with heparin and subsequent neutralization with protamine during immunoadsorption, AM J KIDNEY, 36(3), 2000, pp. 490-497
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.