Deviations in coagulation activation due to treatment with different haemodialysis membranes

Despite systemic heparinization, extracorporeal circulation will induce activation of blood coagulation. Thrombogenicity is associated with biocompatibility of dialysis membranes. Investigation of procoagulatory and fibrinolytic activity is performed prior to and during treatment with haemodialysis. In this study fluctuations of plasma coagulation factor XII, thrombin antithrombin complexes, prothrombin fragment 1 + 2 and thrombus precursor protein were monitored in 10 subjects during treatment with haemodialysis. Subjects were treated with both polysulphone high-flux dialyser membranes (F-60) and low-flux poly-methyl-methacrylate (PMMA) membranes. Immediately after start of treatment, blood in contact with artificial membrane surfaces resulted in a marked decrease in factor XII activity amounting to a mean reduction of 80% in the case of PMMA and a reduction of 40% in the case of F-60. In due course, a steady, on-going generation of thrombin antithrombin complexes was observed in several subjects, especially after treatment with F-60 membranes, amounting to increases exceeding 100% of initial values. Establishment of fibrinogen, prothrombin fragment 1 + 2 and thrombus precursor protein plasma concentrations yielded enhanced results for PMMA compared with the results for treatment with F-60 dialysis membranes. In order to prevent activation of clotting during several stages of haemodialysis, supplementation of anticoagulant can be established on the basis of analytical results of coagulation parameters.