在长期血液透析中优化抗凝策略
Raïsa Thielemans1, Floris Vanommeslaeghe1, Iván Josipovic2
1Nephrology Department, Ghent University Hospital, Ghent, Belgium.
Clinical kidney journal
|November 2, 2023
概括
低分子量肝素 (LMWH) 的单次注射足以进行长期 (夜间) 血液透析 (ENHD),保持透析器的通透性. 监测抗Xa水平可能无法准确预测ENHD患者的纤维阻塞.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 血液学 血液学 血液学
- 医疗器械 医疗器械
背景情况:
- 延长 (夜间) 血液透析 (ENHD) 需要仔细的抗凝管理.
- 在ENHD期间,低分子量肝素 (LMWH) 可以作为单剂或分剂给予.
- 评估LMWH剂量的有效性和对透析器通透性的抗Xa水平的预测值至关重要.
研究的目的:
- 为了确定LMWH的单次注射是否足以在ENHD期间保持透析器纤维通透性.
- 为了调查抗Xa凝固参数是否准确地预测EDHD中的透析器纤维阻塞.
主要方法:
- 一项随机交叉研究,涉及20名稳定的ENHD患者.
- 在周中 ENHD 会议期间,单次和分割的 LMWH (埃诺沙巴林) 注射的比较.
- 用微型计算机断层扫描 (μCT) 测量血抗Xa活性和评估透析器纤维通透率.
主要成果:
- 在单个和分割的LMWH注射组之间,开放透析器纤维的百分比没有显著差异.
- 在这两种施用方法之间,时间平均抗Xa活性水平没有显著差异.
- 抗Xa活性与LMWH剂量相关,但与透析器纤维通透性无关.
结论:
- 单次注射埃诺沙巴林足以用于长达8小时的ENHD会话.
- 监测抗Xa水平以预测透析器通透性的实用性需要进一步研究.
- 目前的发现表明,对ENHD的简化LMWH剂量协议可能是可行的.
相关概念视频
Anticoagulant Drugs: Low-Molecular-Weight Heparins
719
Hemostasis is a crucial process that prevents excessive blood loss from damaged blood vessels. It involves various mechanisms such as vasoconstriction, platelet adhesion and activation, and fibrin formation. The importance of each mechanism depends on the type of vessel injury. In contrast, thrombosis is the abnormal formation of a blood clot within the blood vessels, leading to potential complications if the clot obstructs blood flow. Thrombosis can be caused by increased coagulability of the...
719
Venous Thrombosis III: Interprofessional Care
10
Venous thrombosis requires effective prevention and treatment strategies to improve patient outcomes and reduce potential complications.Prevention StrategiesHealthcare providers must prioritize preventing venous thromboembolism (VTE) for all adult patients upon admission. Interventions depend on bleeding and thrombosis risk, medical history, current medications, diagnoses, planned procedures, and patient preferences. Patients on bed rest should change positions every two hours and, if not...
10
Anticoagulant Drugs: Vitamin K Antagonists and Direct Oral Anticoagulants
1.2K
Oral anticoagulants are vital tools in preventing and treating blood clotting disorders. This diverse class of medications can be categorized as vitamin K antagonists, exemplified by warfarin, and direct thrombin inhibitors (DTIs), such as dabigatran, as well as factor Xa inhibitors, including rivaroxaban.
Warfarin, a prominent vitamin K antagonist family member, exerts its effect by inhibiting the enzyme VKORC1 (vitamin K epoxide reductase complex 1). By hindering this enzyme, warfarin...
Warfarin, a prominent vitamin K antagonist family member, exerts its effect by inhibiting the enzyme VKORC1 (vitamin K epoxide reductase complex 1). By hindering this enzyme, warfarin...
1.2K
Hemodialysis II: Procedure and Complications
26
DialyzersA hemodialysis (HD) dialyzer is a plastic cartridge containing thousands of parallel hollow fibers, which serve as semipermeable membranes. These fibers are typically made from cellulose-based or other synthetic materials. During HD, blood is pumped into the top of the cartridge and distributed among these fibers. Simultaneously, dialysis fluid, known as dialysate, is introduced into the bottom of the cartridge, bathing the outside of the fibers. Across the semipermeable membrane,...
26
Hemodialysis I: Introduction
36
Hemodialysis (HD) is a medical treatment that artificially removes waste products, excess fluids, and toxins from the blood when the kidneys are no longer able to perform these functions effectively. In this process, blood is filtered through a semipermeable membrane, allowing for the selective removal of waste while preserving necessary components like blood cells and proteins. Hemodialysis is typically performed in patients with end-stage renal disease (ESRD) or severe kidney...
36
Continuous Renal Replacement Therapy
38
Continuous Renal Replacement Therapy, also known as CRRT, is a procedural treatment for acute kidney injury (AKI) that gradually removes uremic toxins and fluids while maintaining acid-base balance and stabilizing electrolytes. It is particularly useful for hemodynamically unstable patients. Unlike intermittent hemodialysis, which is faster, CRRT provides a gentler approach over 24 hours, closely mimicking the function of natural kidneys. However, CRRT is not ideal for patients with...
38


