Inhibitors of Coagulation in Terminal Renal Failure and during Hemodialysis

Effect of Desmopressin (DDAVP) on Protein C and Protein C Inhibitors in Uremia

“…In the present study, we showed, as previously reported, that baseline PC activity is lower in uremic patients [7][8][9][10] and DDAVP leads to further decrease in PC activity but does not influence the level of PC antigen in uremia [10]. Anyway, even normal controls exhibited a decrease in PC activity after DDAVP, providing evidence that this could be a general phenomenon unrelated to chronic uremia.…”

“…A significant increase in platelet serotonin uptake and ATP release was observed after DDAVP treatment in uremic individuals and this may play a critical role in shortening bleeding time [6]. Besides, a low activity of protein C (PC), a serine proteinase which func tions in the vascular system as a potent anticoagulant, has been described in uremia [7][8][9] and PC activity is further reduced after infusion of DDAVP in uremic patients and it has been suggested that this further decrease in PC activity might contribute to the explanation of the normalization of the bleeding tendency after DDAVP infusion [10] because a reduction in PC activity results in a prethrombotic state [9], Regarding the mechanism by which DDAVP decreases the PC activity Aunsholt et al [10] have speculated in this journal that an influence of DDAVP on the specific PC inhibitor may be possible.…”

Protein C and Its Inhibitors during Hemodialysis

“…I n the present study, it is shown, as previ ously reported [1,2], that PCA is low in uremic patients, and a single hemodialysis session restores this defect. The determined increase in PAI-3 by virtue of dialysis in this study was thought to be due to the ability of heparin, given as anticoagulant during dial ysis, to accelerate protease inhibition by he parin-dependent protein C inhibitor (PAI-3) [5].…”

“…On the other hand, Knudsen et al [2] had shown that protein C activity (PC'A) in creased acutely during hemodialysis, the un derlying mechanism, however, was unclear, and they had speculated the presence of an unknown dialyzable inhibitor of protein C in uremic plasma. In order to clarify the role of protein C inhibitors in the genesis of pro tein C changes during hemodialysis, we stud ied the two well-known protein C inhibitors, namely, plasminogen activator inhibitor-3 (PAI-3) and «,-antitrypsin ( a r AT) [3,4] be sides PCA before and after hemodialysis in uremic patients on regular dialysis.…”