PMID- 18446715
OWN - NLM
STAT- MEDLINE
DCOM- 20080826
LR  - 20101118
IS  - 1121-8428 (Print)
IS  - 1121-8428 (Linking)
VI  - 21
IP  - 2
DP  - 2008 Mar-Apr
TI  - Effects of dermatan sulfate for anticoagulation in continuous renal replacement 
      therapy.
PG  - 205-12
AB  - BACKGROUND: Dermatan sulfate (DS) is a natural glycosaminoglycan with a unique 
      mechanism of action on the coagulation system. Unlike unfractionated heparin 
      (UFH), DS selectively inhibits thrombin, does not inhibit factor Xa, is effective 
      on both free and fibrin-bound thrombin and does not interfere with platelets. 
      This study represents the first experience using DS as anticoagulant in patients 
      on continuous renal replacement therapy (CRRT). METHODS: A total of 147 patients 
      in our intensive care unit who developed acute renal failure after cardiovascular 
      surgery were on CRRT according to the same protocol: machine, Gambro Prisma; 
      filter, AN69, 0.9 m2; QB, 150 ml/min; QD, 2,000 ml/hour; and Q(Infusate), 500 
      ml/hour. In a retrospective cohort of 100 patients, anticoagulation was performed 
      with UFH (UFH-CRRT): initial bolus of 530 +/- 363 IU, then i.v. infusion of 598 
      +/- 261 IU/hour. A prospective cohort of 47 patients received DS (DS-CRRT) as a 
      150-mg bolus followed by a 13.5 +/- 3 mg/hour infusion. Hematology tests were 
      performed at baseline and during CRRT; filter lifetime was measured from the 
      start to filter clotting. RESULTS: Median filter lifetime was 58 hours in DS-CRRT 
      vs. 47 hours in UFH-CRRT (p<0.001). No differences emerged in basal hematology 
      and hemostasis tests between groups. During CRRT, DS produced a smaller activated 
      partial thromboplastin time increase than UFH (p<0.01). Platelet count exhibited 
      a comparable small decline in both DS-CRRT and UFH-CRRT (p<0.01). No significant 
      bleeding episodes occurred during DS-CRRT. In-hospital mortality was similar in 
      the 2 cohorts. CONCLUSIONS: DS can be suggested as an anticoagulant for CRRT in 
      patients who develop acute renal failure following major cardiovascular surgery.
FAU - Vitale, Corrado
AU  - Vitale C
AD  - Nephrology and Dialysis Unit, ASO Ordine Mauriziano, Torino, Italy. 
      covitale@libero.it
FAU - Verdecchia, Claudio
AU  - Verdecchia C
FAU - Bagnis, Cristiana
AU  - Bagnis C
FAU - Ganzaroli, Marco
AU  - Ganzaroli M
FAU - Giorcelli, Giovanni
AU  - Giorcelli G
FAU - Marangella, Martino
AU  - Marangella M
LA  - eng
PT  - Journal Article
PL  - Italy
TA  - J Nephrol
JT  - Journal of nephrology
JID - 9012268
RN  - 0 (Anticoagulants)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 24967-94-0 (Dermatan Sulfate)
SB  - IM
MH  - Acute Kidney Injury/etiology/*therapy
MH  - Aged
MH  - Anticoagulants/*administration & dosage
MH  - Cardiovascular Surgical Procedures/adverse effects
MH  - Dermatan Sulfate/*administration & dosage
MH  - Female
MH  - *Hemodiafiltration
MH  - Heparin, Low-Molecular-Weight/administration & dosage
MH  - Humans
MH  - Infusions, Intravenous
MH  - Injections, Intravenous
MH  - Male
MH  - Partial Thromboplastin Time
EDAT- 2008/05/01 09:00
MHDA- 2008/08/30 09:00
CRDT- 2008/05/01 09:00
PHST- 2008/05/01 09:00 [pubmed]
PHST- 2008/08/30 09:00 [medline]
PHST- 2008/05/01 09:00 [entrez]
PST - ppublish
SO  - J Nephrol. 2008 Mar-Apr;21(2):205-12.