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Platelet-related hemostasis before and after hemodialysis with five different anticoagulation methods
Knehtl, Maša ; Ponikvar, Rafael ; Buturović-Ponikvar, Jadranka
Purpose: To evaluate platelet-related hemostasis during hemodialysis performed with five different anticoagulation methods. Methods: 31 chronic hemodialysis patients, 71% men, aged 57.5 17.4 years, ...participated in our prospective study. Platelet function analyzer PFA -100 closure time (collagen/epinephrine -CEPI, collagen/adenosine diphosphate -CADP) was measured before and after hemodialysis, which was performed consecutively with five different anticoagulation methods: full-dose unfractionated heparin (UFH) and low-molecular weight heparin (LMWH): 31 patients, regional citrate anticoagulation (RCA): 28 patients, low-dose heparin: 25 patients and heparin-free dialysis: 9 patients. The degree of clotting in the dialysis system was graded on a 5 point scale. Results: CEPI (mean SD, reference range 80-160 sec) before vs. after hemodialysis: UFH: 171.7 62.1 vs. 170.8 67.3; LMWH: 167.4 56.9 vs. 159.4 56.4; low-dose heparin: 175.3 69.0 vs. 183.1 60.5; RCA: 172.6 57.4 vs. 161.6 57.0; heparin-free: 181.7 56.8 vs. 209.0 66.5; all differences nonsignificant. CADP (mean SD, reference range: 68-121 sec) before vs. after hemodialysis: UFH: 132.0 56.6 vs.146.3 68.4; LMWH: 132.4 57,0 vs. 123.1 50.8; low-dose heparin: 137.2 64.2 vs. 143.8 55.5; RCA: 140.7 48.2 vs. 132.9 48.1; heparin-free: 137.1 68.0 vs.139.2 29.7; all differences nonsignificant. Before hemodialysis procedure CEPI was increased in 51.2% and CADP in 48.4% of the patients. The best dialysis system clotting score was found with UFH, LMWH and RCA.Conclusions: Platelet dysfunction was demonstrated in approximately half of the chronic hemodialysis patients and was not improved after hemodialysis, regardless of the anticoagulation regimen used.
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