Author/Editor		Čede, Zora; Andoljšek, Dušan
Title		Odnos med koncentracijo heparina v plazmi in motnjo v koagulaciji: zdravljenje s heparinom med hemodializo
Translated title		Relation between plasma heparin concentration and clotting disturbance during heparin hemodialysis
Type		članek
Source		Zdrav Vestn
Vol. and No.		Letnik 67, št. Suppl 1
Publication year		1998
Volume		str. I-65-8
Language		slo
Abstract		Background. There are several assays of heparin pharmacological effect but it is unknown assay yields the best information with regard to anticoagulant effect. The commonly used is activated partial thromboplastin time (APTT). We used it to study patients with chronic renal insufficiency on hemodialysis with heparin and the relation between heparin concentration and its antithrombin effect. Patients and methods. Hemodialysis (HD) was started with unfractioned heparin in bolus (mean 30 i.u./kg b.w.) and than followed by infusion (mean 16, i.u/kg b/w./hour). APTT, plasma heparin concentration and antithrombin activity (AT III) was measured in 22 episodes of heparin HD in 11 patients with chronic renal insufficiency. Pathromtin (Behringwerke AG, Germany) was used for measurements of APTT, Antithrombin III Reagent (Behringwerke, AG, Germany) for antithrombin III activity, and berichrom Heparin (Behringwerke AG, Germany) for plasma heparin concentration. The latter was photometrically, using chromogenic substrate and heparin dilution curve. Results. Plasma heparin concentration become stable at 120. minutes of HD when steady state seems to be reached. After that there were no significant changes in plasma heparin concentration. Heparin antithrombin activity measured by APTT was unpredictable up to 120. minutes of HD. After that the heparin effect was more predictable: 0.10 i.u./ml prolongs APTT for aprox. 21.5 s. Conclusions. APTT does not seem to be a very suitable test for measuring the anticoagulant (antithrombin) effect of heparin until steady state is achieved. It is only from that time on that the APTT results can be used for adjusting heparin dosage.
Summary		Izhodišča. Ni znano, kateri od testov daje najboljšo informacijo o antikoagulacijskem učinku heparina. Zelo uporabljan je aktivirani parcialni tromboplastinski čas (aPTČ). Hoteli smo ugotoviti, kakšen je odnos med koncentracijo heparina v plazmi in motnjo v koagulaciji, ocenjeno prek aPTČ. Za model smo imeli stacionarno stanje kronične ledvične odpovedi in heparinsko hemodializo (HD). Bolniki in metode. HD so začeli s heparinom v bolusu (povprečno 30 i.e./kg telesne teže) in nadaljevali z infuzijo (povprečno 16,1 i.e.kg telesne teže/uro). Določili smo aPTČ, koncentracijo hepaina in aktivnost antitrombina III (AT III) v poteku 22 epizod HD pri enajstih bolnikih s kronično ledvično odpovedjo. Za aPTČ smo rabili Pathromtin (Bebringwerke AG, Marburg, Nemčija). Koncentracijo heparina smo določili fotometrično s kromogenim substratom Berichrom Heparin (Behringwerke AG) in s pomočjo umeritvene krivulje z raličnimi koncentracijami heparina, aktivnost antitrombina III (AT III) s pomočjo Antitrombin III Reagent (Behringwerke AG)> Statistično pomembne so bile razlike, kjer je p<0,05. Rezultati. Koncentracija heparina v plazmi se ustali po 120. minuti po začetku zdravljenja, ko je doseženo stacionarno stanje. Zatem se koncentracija heparina ne spremenja pomembno. V začetku je učinek heparina, merjen prek aPTČ, nepredvidljiv. PO 120. minuti po začetku pa je bolj predvidljiv: za dodanih 0,10 i.e./ml heparina se aPTČ podaljša v povprečju za 21,5 s. Zaključek. APTČ ni posebno primeren test za oceno antikoagulacijskega (antitrombinskega) učinka heparina v začetku zdravljenja, dokler ni doseženo stacionarno stanje. Še potem aPTČ lahko rabimo za prilagajanje odmerka heparina za zdravljenje.
Descriptors		HEMODIALYSIS HEPARIN PARTIAL THROMBOPLASTIN TIME ANTITHROMBIN III HEMODIALYSIS SOLUTIONS KIDNEY FAILURE, CHRONIC