A comparison of ticlopidine and heparin on hemodialysis in dogs

The efficacies of low-dose heparin and low-dose heparin plus ticlopidine as anticoagulants during hemodialysis in acutely uremic dogs were compared and evaluated. Heparin was administered as a bolus at a dose of 100 U/kg. In preliminary experiments it was determined that dogs dialyzed with ticlopidine alone demonstrated gross clotting of the artificial kidney within 2.5 hr. Ticlopidine was administered by gavage at a dose of 50 mg/kg/day starting 72 hr prior to hemodialysis and continuing throughout the period of hemodialysis (4 days). Each dog was dialyzed four times with either heparin alone or heparin plus ticlopidine. Each hemodialysis lasted 3.5 hr. Parameters followed included dialysis clearance of urea and creatinine, ultrafiltration rate, residual blood volume, gross clotting episodes, platelet count, and levels of fibrinogen and thromboxane B2. A lesser degree of hemodialysis-associated thrombocytopenia, a lower residual blood volume, fewer episodes of gross clotting, no reduction in fibrinogen levels, and no increase in thromboxane B2 levels were observed in the heparin plus ticlopidine group as compared to the heparin group alone. Although ticlopidine at the dosage employed should not be used as the sole anticoagulant for hemodialysis, it may be useful when added to low-dose heparin. The salutary effects demonstrated in this study suggest clinical benefits of the combination.