PMID- 16550749
OWN - NLM
STAT- MEDLINE
DCOM- 20060620
LR  - 20190608
IS  - 0301-0430 (Print)
IS  - 0301-0430 (Linking)
VI  - 65
IP  - 3
DP  - 2006 Mar
TI  - The use of PEG-Hirudin in chronic hemodialysis monitored by the Ecarin Clotting 
      Time: influence on clotting of the extracorporeal system and hemostatic 
      parameters.
PG  - 180-90
AB  - AIM: The aim of our study was to investigate the use of polyethylene glycol 
      (PEG)-Hirudin (PEG-H) as an anticoagulant in hemodialysis including drug 
      monitoring with the Ecarin Clotting Time (ECT) in whole blood and to compare this 
      regimen with standard anticoagulant unfractionated heparin (UFH) for influence on 
      hemostatic parameters and clot frequency of the extracorporeal system. PATIENTS 
      AND METHODS: The application of PEG-H as an anticoagulant in patients on chronic 
      HD was studied in 20 patients (12 males, 8 females) from a single center in an 
      exploratory, open-label, controlled, single-blind, dose-finding study. The 
      patients were divided in 2 groups with 10 patients each (Group I and II); both 
      received 3 dialyses with UFH, thereafter Group I received 5 dialyses with PEG-H 
      and Group II 10 dialyses with PEG-H. Starting dose of PEG-H in the first dialysis 
      was a bolus of 0.08 mg/kg bwt, the mean dose of the following HD was 0.041 mg/kg 
      bwt (range 0.026 0.065 mg/kg bwt). PEG-H was applied as an intravenous bolus-dose 
      followed by a 0.9% saline as a placebo-infusion. HD was performed regularly 3 
      times a week. All dialysis treatments were performed exclusively with a hollow 
      fiber dialyzer type. Fibrinogen, antithrombin III, prothrombin fragments, 
      thrombin-antithrombin and soluble fibrin were measured with commercial tests. ECT 
      was determined in a mechanical coagulometer. A semiquantitative score was given 
      for the presence of clots in the extracorporeal system after each dialysis. 
      RESULTS: PEG-H was effectively used as an anticoagulant in 150 chronic dialysis 
      treatments using ECT as a simple monitoring method. The optimal whole blood 
      concentration for PEG-H is 600-1000 ng/ml. Clotting in the whole extracorporeal 
      system was decreased by 45% (p = 0.059) with PEG-H anticoagulated HD in 
      comparison to UFH. Fibrinogen, prothrombin fragments (F1+2-fragments) and 
      thrombin-antithrombin-complex showed no significant change in comparison with 
      UFH, antithrombin III (AT III) increased to normal concentrations. Highly 
      sensitive coagulation markers such as a soluble fibrin showed a significant 
      decrease (p < 0.001) before and after HD with PEG-H compared with UFH. 
      CONCLUSION: PEG-H can be used effectively as an alternative anticoagulant in 
      patients on chronic HD using ECT as a simple drug monitoring method. The lower 
      frequency of clots in the extracorporeal system, the stronger and more efficient 
      inhibition of coagulation during HD as indicated by soluble fibrin, may have a 
      positive influence on the disturbed blood coagulation of these patients.
FAU - Ulbricht, K
AU  - Ulbricht K
AD  - Department of Internal Medicine III, Friedrich-Schiller-University Jena, Germany. 
      Kristina.Ulbricht@med.uni-jena.de
FAU - Bucha, E
AU  - Bucha E
FAU - Poschel, K A
AU  - Poschel KA
FAU - Stein, G
AU  - Stein G
FAU - Wolf, G
AU  - Wolf G
FAU - Nowak, G
AU  - Nowak G
LA  - eng
PT  - Controlled Clinical Trial
PT  - Journal Article
PL  - Germany
TA  - Clin Nephrol
JT  - Clinical nephrology
JID - 0364441
RN  - 0 (Anticoagulants)
RN  - 0 (Hirudins)
RN  - 0 (polyethyleneglycol-hirudin)
RN  - 9005-49-6 (Heparin)
RN  - EC 3.4.- (Endopeptidases)
RN  - EC 3.4.24.- (ecarin)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Anticoagulants/therapeutic use
MH  - Blood Coagulation/*drug effects
MH  - *Endopeptidases
MH  - Enzyme Activation
MH  - *Extracorporeal Membrane Oxygenation
MH  - Female
MH  - Follow-Up Studies
MH  - Heparin/therapeutic use
MH  - Hirudins/*administration & dosage
MH  - Humans
MH  - Injections, Intravenous
MH  - Kidney Failure, Chronic/blood/*therapy
MH  - Male
MH  - Middle Aged
MH  - Renal Dialysis/*instrumentation
MH  - Single-Blind Method
MH  - Treatment Outcome
MH  - Whole Blood Coagulation Time
EDAT- 2006/03/23 09:00
MHDA- 2006/06/21 09:00
CRDT- 2006/03/23 09:00
PHST- 2006/03/23 09:00 [pubmed]
PHST- 2006/06/21 09:00 [medline]
PHST- 2006/03/23 09:00 [entrez]
AID - 10.5414/cnp65180 [doi]
PST - ppublish
SO  - Clin Nephrol. 2006 Mar;65(3):180-90. doi: 10.5414/cnp65180.