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Hemodialysis with defibrotide: effects on coagulation parameters
E Filimberti1, S Cinotti, M Salvadori
1Hemophilia Center, Careggi Hospital, USL 10/D, Firenze, Italy.
The International Journal of Artificial Organs
|October 1, 1992
Summary
Defibrotide demonstrates antithrombotic activity during hemodialysis, increasing protein C activity and free protein S. Unlike heparin, defibrotide
Area of Science:
- Nephrology
- Hematology
- Pharmacology
Background:
- Hemodialysis patients often experience coagulation system alterations.
- Heparin is commonly used to prevent clotting during dialysis but can have limitations.
Purpose of the Study:
- To compare the effects of defibrotide and heparin on blood coagulation parameters in uremic patients undergoing hemodialysis.
- To assess the antithrombotic efficacy and safety of defibrotide in dialysis.
Main Methods:
- Crossover study with eight uremic patients on hemodialysis.
- Comparison of heparin (100 IU/kg) and defibrotide (400 mg repeated) effects on coagulation.
- Assessed coagulation parameters (VIII:C, AT III, TAT, PC antigen/activity, PS, FPA) pre-dialysis and at 2, 3, and 4 hours.
Main Results:
- Heparin increased Factor VIII:C and Antithrombin III.
- Defibrotide showed evidence of thrombin activation (increased FPA, TAT) but also increased protein C activity and free protein S.
- Both modalities raised protein C levels; defibrotide uniquely increased protein C activity and PS.
Conclusions:
- Defibrotide exhibits antithrombotic activity during hemodialysis.
- Defibrotide's antithrombotic action appears independent of direct thrombin neutralization.
- Defibrotide is a potential alternative anticoagulant for hemodialysis with no observed adverse reactions or fibrin formation.