Acute dialysis : PMN-elastase as a new parameter for controlling individual anticoagulation with low molecular weight heparin (Fragmin®)

Despite the improvements in the development of dialyzer membranes with greater hemocompatibility, an activation of the coagulation system occurs when blood comes into contact with exogenous surfaces. The large number of heparin dosage regimens demonstrated the difficulty to adapt general therapeutic...

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Bibliographic Details
Published in:Intensive care medicine 1991, Vol.17 (1), p.52-56
Main Authors: SWARS, H, HAFNER, G, WEILEMANN, L. S, EHRENTHAL, W, SCHINZEL, H, PRELLWITZ, W, MEYER, J
Format: Article
Language:English
Subjects:
Acute Kidney Injury - blood
Acute Kidney Injury - drug therapy
Acute Kidney Injury - therapy
Aged
Antithrombin III - chemistry
Biological and medical sciences
Blood. Blood coagulation. Reticuloendothelial system
Female
Heparin, Low-Molecular-Weight - administration & dosage
Heparin, Low-Molecular-Weight - pharmacokinetics
Heparin, Low-Molecular-Weight - therapeutic use
Humans
Leukocyte Elastase
Male
Medical sciences
Middle Aged
Pancreatic Elastase - blood
Peptide Hydrolases - chemistry
Pharmacology. Drug treatments
Renal Dialysis - adverse effects
Thrombosis - blood
Thrombosis - drug therapy
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Summary:Despite the improvements in the development of dialyzer membranes with greater hemocompatibility, an activation of the coagulation system occurs when blood comes into contact with exogenous surfaces. The large number of heparin dosage regimens demonstrated the difficulty to adapt general therapeutic guidelines. Low molecular weight heparin (Fragmin) was administered as a single bolus dose for anticoagulation during 58 acute dialyses. Anti-Xa-activity, the plasma levels of the lysosomal elastase of the polymorphonuclear granulocytes ("PMN-elastase") and of the thrombin-antithrombin III-complex (TAT) were measured at hourly intervals. Therapeutic anti-Xa-levels did not show evidence of sufficient inhibition of thrombin formation. The PMN-elastase increased by 180 ng/ml 3 h after administration of the bolus dose, with no further increase occurring (plateau phase). This was considered to reflect adequate anticoagulative activity. Where anticoagulation was inadequate, the elastase values rose consistently. After 2 h the increase of the PMN-elastase showed that--and to what extent--coagulation had been activated. The determination of PMN-elastase, using the IMAC-principle, is a method which can be performed quickly with any conventional autoanalyzer. It makes it possible to monitor adequate anticoagulation, but PMN-elastase results must be proven during routine use before recommendation as a routine test.
ISSN:0342-4642
1432-1238
DOI:10.1007/BF01708410