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In Vitro Thrombosis Test for Ventricular Assist Devices
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Evaluation of three different methods to prevent dialyzer clotting without causing systemic anticoagulation effect.

Pavlina Richtrova1, Kamila Rulcova, Jan Mares

  • 1Department of Internal Medicine I, Charles University, Medical School and Teaching Hospital, Plzen, Czech Republic. richtrovap@fnplzen.cz

Artificial Organs
|July 15, 2010
PubMed
Summary

Regional citrate anticoagulation (RCA) is the most effective method for reducing thrombogenicity during intermittent hemodialysis (IHD) when systemic anticoagulants are contraindicated. RCA significantly reduced clotting and thrombin-antithrombin complex production compared to saline flushes or the AN69 ST membrane.

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Published on: September 5, 2017

Area of Science:

  • Biomaterials Science
  • Nephrology
  • Hematology

Background:

  • Thrombogenicity is a critical biocompatibility marker for artificial materials used in medical devices.
  • Extracorporeal circuits (ECC) in intermittent hemodialysis (IHD) often require anticoagulation to prevent clotting.
  • Systemic anticoagulants may be contraindicated in certain patient populations, necessitating alternative strategies.

Purpose of the Study:

  • To compare the thrombogenicity of three different methods during IHD without systemic anticoagulation.
  • To evaluate the efficacy of regular saline flushes, regional citrate anticoagulation (RCA), and the AN69 ST membrane in preventing ECC clotting.
  • To assess key thrombogenicity parameters including platelet count, platelet factor 4 (PF4), and thrombin/antithrombin complexes (TAT).

Main Methods:

  • A prospective, randomized, crossover study involving 10 stable IHD patients.
  • Comparison of three anticoagulation strategies: saline flushes, RCA, and AN69 ST membrane.
  • Measurement of platelet count, PF4, and TAT at baseline and at 10, 60, 120, and 240 minutes during IHD.

Main Results:

  • All 10 RCA procedures were completed successfully (4 hours), while saline flushes and AN69 ST led to premature termination due to clotting in 6/10 and 5/10 cases, respectively (P < 0.05).
  • Significantly increased TAT production was observed with saline flushes and AN69 ST compared to RCA (P < 0.05).
  • Platelet activation (elevated PF4) occurred with all methods, but coagulation cascade activation was significantly lower with RCA.

Conclusions:

  • Regional citrate anticoagulation (RCA) is the most effective method for reducing thrombogenicity during IHD among the evaluated strategies.
  • RCA offers a superior safety profile and efficacy in preventing extracorporeal circuit clotting compared to saline flushes and the AN69 ST membrane.
  • These findings support RCA as a viable alternative when systemic anticoagulation is not feasible in IHD patients.