Effectiveness of Activated Clotting Time in Monitoring Heparin Dosage during Hemodialysis

使用活化凝血時間監測血液透析時肝素劑量之有效性評估

呂至剛(Jyh-Gang Leu) ； 江守山(Shou-Shan Chiang)

《Acta Nephrologica》 22卷1期 (2008/03) Pp. 56-58

摘要

Background and Purpose: A rapid and cheap bedside test for heparin monitoring is needed for hemodialysis patients. We compared the efficacy of activated partial thromboplastin time (APTT), anti-factor Xa (anti-Xa) activity, and activated clotting time (ACT) in monitoring the anticoagulation effect of unfractionated heparin (UFH) and low-molecular-weight heparin (LMWH).
Methods: In patients using LMWH (n=18), a bolus injection of LMWH was given at the start of a hemodialysis session. In patients using UFH (n=20), a bolus of UFH at the start of dialysis was followed by a hemodialysis session. In patients using UFH (n=20), a bolus of UFH at start of dialysis was followed by a maintenance dosage throughout dialysis (mean total dosage 2325±591 IU).
Results: In patients using LMWH, the mean total LMWH dosage was 961±409 IU. The mean value of plasma anti-Xa activity increased from 0.03±0.04 IU/ml before dialysis to 0.21±0.15 IU/ml after 2 hours of dialysis; the change in mean value of APTT was from 37.0±3.6 seconds before dialysis to 41.4±5.7 seconds (an 11% increase) after 2 hours of dialysis. No significant change in ACT was noted throughout the whole study period (from 190±18 seconds before dialysis to 188±19 seconds after 2 hours of dialysis). In patients using UFH, the mean value of APTT was 33.7±3.2 seconds before dialysis and 46.3±12.8 seconds (37% increase) after 2 hours of dialysis. The mean value of ACT increased from 177±24 seconds before dialysis to 189±17 seconds after 2 hours of dialysis (6.7% increase, P＜0.01). The difference in ACT before and after UFH administration may be too small for effective monitoring of UFH dosage.
Conclusions: We conclude that ACT is not good enough for monitoring the optimal dosage of UFH or LMWH during hemodialysis.

關鍵字

血液透析 ； 低分子量肝素 ； 肝素 ； 活化凝血時間

並列摘要

Background and Purpose: A rapid and cheap bedside test for heparin monitoring is needed for hemodialysis patients. We compared the efficacy of activated partial thromboplastin time (APTT), anti-factor Xa (anti-Xa) activity, and activated clotting time (ACT) in monitoring the anticoagulation effect of unfractionated heparin (UFH) and low-molecular-weight heparin (LMWH).
Methods: In patients using LMWH (n=18), a bolus injection of LMWH was given at the start of a hemodialysis session. In patients using UFH (n=20), a bolus of UFH at the start of dialysis was followed by a hemodialysis session. In patients using UFH (n=20), a bolus of UFH at start of dialysis was followed by a maintenance dosage throughout dialysis (mean total dosage 2325±591 IU).
Results: In patients using LMWH, the mean total LMWH dosage was 961±409 IU. The mean value of plasma anti-Xa activity increased from 0.03±0.04 IU/ml before dialysis to 0.21±0.15 IU/ml after 2 hours of dialysis; the change in mean value of APTT was from 37.0±3.6 seconds before dialysis to 41.4±5.7 seconds (an 11% increase) after 2 hours of dialysis. No significant change in ACT was noted throughout the whole study period (from 190±18 seconds before dialysis to 188±19 seconds after 2 hours of dialysis). In patients using UFH, the mean value of APTT was 33.7±3.2 seconds before dialysis and 46.3±12.8 seconds (37% increase) after 2 hours of dialysis. The mean value of ACT increased from 177±24 seconds before dialysis to 189±17 seconds after 2 hours of dialysis (6.7% increase, P＜0.01). The difference in ACT before and after UFH administration may be too small for effective monitoring of UFH dosage.
Conclusions: We conclude that ACT is not good enough for monitoring the optimal dosage of UFH or LMWH during hemodialysis.

並列關鍵字

Hemodialysis ； Low molecular weight heparin ； activated clotting time ； Heparin