Resumo

SANCHEZ-CANEL, Juan J. et al. Evaluation of coagulation and anti-Xa factor using a heparin-coated AN69ST^® dialyser. Nefrología (Madr.) [online]. 2012, vol.32, n.5, pp.605-612. ISSN 1989-2284.  https://dx.doi.org/10.3265/Nefrologia.pre2012.Jun.11486.

Background: Haemodialysis systems are potentially thrombogenic, so anticoagulation is routinely used. Its prescription involves certain risks, despite which the recommendations regarding dosage are still based on very disparate criteria. Methods: We performed a randomised, crossed pilot study. Six patients underwent six sessions of post-dilution haemodiafiltration with a polysulfone HF80^® dialyser and standard anticoagulation with nadroparin, and six sessions with heparincoated poliacrylonitrile AN69ST^® membrane without the administration of systemic anticoagulation therapy. The coagulation level of the dialyser and extracorporeal circuit was evaluated every hour using a visual scale along with variation in clotting parameters such as anti-Xa factor. Our primary objective was to assess anti-Xa activity in the absence of differences in the rate of massive coagulation between the two groups. Results: No complete or grade 4 dialyser clotting occurred in any of the 36 sessions with either dialyser. Partial clotting of the dialyser occurred below 25% (grade 1-2) in 32 (88.9%) AN69ST^® sessions and 35 (97.2%) sessions using the standard dialyser, and partial clotting surpassed 25% (grade 3-4) in 4 (11.1%) AN69ST^® sessions and 1 (2.8%) dialysis session with heparin. Arterial chamber blood clotting did not surpass 25% (grade 3 and 4) in any of the studied sessions, and venous chamber coagulation occurred in only 1 (2.8%) session with the usual dialyser and in 3 (8.4%) sessions with the AN69ST^®, with no significant differences between the two dialysers. The activated partial thromboplastin time at two hours showed differences between the two techniques in correlation with the administration of low molecular weight heparin (33.3±2.7s with polysulfone and 27.5±2.3s in AN69ST^®; P<0.05), which remained significant at the end of the session (29.8±2.1s with polysulfone and 27.2±1.8s with AN69ST^®; P<0.05). Anti-Xa factor activity reached a maximum at two hours after the administration of nadroparin, with differences between the two dialysers (0.46±0.13IU/ml in dialysis with polysulfone and 0.04±0.04IU/ml with AN69ST^®; P<0.05), and levels decreased after 4 hours (0.17±0.12IU/ml in dialysis with polysulfone and 0.02±0.03IU/ml in AN69ST^®; P<0.05). One patient on dialysis with AN69ST^® had an adverse reaction in the form of generalised pruritus and was excluded from the study, by withdrawing consent for participation in the first session. Conclusion: We demonstrate the low thrombogenicity of the AN69ST^® dialyser, allowing for postdilution haemodiafiltration sessions without systemic anticoagulation therapy and without increasing the frequency of severe coagulation events as compared to the HF80^® dialyser with nadroparin, with a lower associated risk of bleeding by not modifying anti-Xa factor activity.

Palavras-chave : Anti-Xa; Coagulation; Heparin; Haemodialysis; Haemodialysis membrane.

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