PMID- 20185164
OWN - NLM
STAT- MEDLINE
DCOM- 20100922
LR  - 20131121
IS  - 1879-2472 (Electronic)
IS  - 0049-3848 (Linking)
VI  - 126
IP  - 1
DP  - 2010 Jul
TI  - Heparin versus prostacyclin in continuous hemodiafiltration for acute renal 
      failure: effects on platelet function in the systemic circulation and across the 
      filter.
PG  - 24-31
LID - 10.1016/j.thromres.2010.01.048 [doi]
AB  - Continuous venovenous hemodiafiltration (CVVHDF) is the treatment of choice for 
      critically-ill patients suffering from acute renal failure (ARF). One major 
      problem of extracorporeal circuits is their thrombogenicity, which requires 
      pharmacological blockade of primary (platelet-dependent) or secondary (plasmatic) 
      haemostasis, increasing the patient's bleeding risk. Our study assessed platelet 
      function during CVVHDF, comparing anticoagulant versus antiplatelet 
      pharmacological strategies, commonly used to avoid circuit clotting. Twenty-three 
      critically-ill patients with ARF, requiring CVVHDF were randomized to a 
      prostacyclin analogue (PGI) or to unfractionated heparin (UFH). Ex vivo platelet 
      function, assessed by optical aggregometry (OPA) induced by collagen or ADP, was 
      studied in peripheral blood at baseline, 4 and 24 hrs after starting CVVHDF, and 
      at 4 hrs within the circuit, before and after the filter (n=9). Coagulation was 
      also monitored. PGI significantly inhibited ADP-induced OPA of peripheral 
      platelets: maximal aggregation (Tmax) was reduced at 4 and 24 hrs by 20%, while 
      collagen-induced Tmax was significantly reduced at 4 hrs only. In the UFH group, 
      collagen-induced OPA in peripheral platelets was significantly inhibited: slopes 
      of OPA tracings were decreased by 25%, lag time was prolonged by 22%, Tmax 
      decreased by 10% already at 4 hrs. ADP-induced OPA showed a similar, but 
      non-significant trend. UFH expectedly prolonged aPTT. In the UFH group, platelet 
      responsiveness to collagen was significantly increased by 30% in post-filter 
      versus pre-filter samples. This effect was blunted in the PGI group. UFH does not 
      protect platelets from filter-induced activation and is associated with a reduced 
      function of systemic platelets. Platelet-inhibiting agents might better prevent 
      the activatory effect of the filter.
CI  - Copyright (c) 2010 Elsevier Ltd. All rights reserved.
FAU - Arcangeli, Andrea
AU  - Arcangeli A
AD  - Istituto Anestesia e Rianimazione, Policlinico Agostino Gemelli, Catholic 
      University School of Medicine, Largo Francesco Vito 1, 00168 Rome, Italy. 
      andrea.arcangeli@rm.unicatt.it
FAU - Rocca, Bianca
AU  - Rocca B
FAU - Salvatori, Gabriella
AU  - Salvatori G
FAU - Ciancia, Mariano
AU  - Ciancia M
FAU - De Cristofaro, Raimondo
AU  - De Cristofaro R
FAU - Antonelli, Massimo
AU  - Antonelli M
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
DEP - 20100224
PL  - United States
TA  - Thromb Res
JT  - Thrombosis research
JID - 0326377
RN  - 0 (Anticoagulants)
RN  - 9005-49-6 (Heparin)
RN  - DCR9Z582X0 (Epoprostenol)
SB  - IM
MH  - Acute Kidney Injury/blood/drug therapy/*therapy
MH  - Aged
MH  - Anticoagulants/pharmacology/therapeutic use
MH  - Blood Coagulation/drug effects
MH  - Blood Coagulation Disorders/drug therapy/therapy
MH  - Blood Platelets/drug effects
MH  - Critical Illness/therapy
MH  - Epoprostenol/pharmacology
MH  - Female
MH  - Filtration
MH  - Hemodiafiltration
MH  - Hemorrhage/drug therapy/therapy
MH  - Hemostasis/*drug effects
MH  - Heparin/*pharmacology/*therapeutic use
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Partial Thromboplastin Time
MH  - Platelet Count
MH  - Prospective Studies
MH  - Renal Dialysis
EDAT- 2010/02/27 06:00
MHDA- 2010/09/24 06:00
CRDT- 2010/02/27 06:00
PHST- 2009/11/24 00:00 [received]
PHST- 2010/01/27 00:00 [revised]
PHST- 2010/01/27 00:00 [accepted]
PHST- 2010/02/27 06:00 [entrez]
PHST- 2010/02/27 06:00 [pubmed]
PHST- 2010/09/24 06:00 [medline]
AID - S0049-3848(10)00103-9 [pii]
AID - 10.1016/j.thromres.2010.01.048 [doi]
PST - ppublish
SO  - Thromb Res. 2010 Jul;126(1):24-31. doi: 10.1016/j.thromres.2010.01.048. Epub 2010 
      Feb 24.