Rinsing the Extra Corporeal Circuit with a Heparin and Albumin Solution Reduces the Need for Systemic Anticoagulant in Hemodialysis

Fransson, Filip; Kyrk, Tobias; Skagerlind, Malin; Stegmayr, Bernd

doi:10.5301/ijao.5000253

Cited by 14 publications

(13 citation statements)

References 10 publications

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“…The results from the present large population study support the results of safety and efficacy using HA priming that was indicated in a previous small pilot study . This extended study also showed that a large patient group, than previously reported, was able to complete IHD without any addition of UFH.…”

Section: Discussionsupporting

confidence: 91%

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Heparin albumin priming in a clinical setting for hemodialysis patients at risk for bleeding

Skagerlind

Stegmayr

2016

Hemodialysis International

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Section: Discussionsupporting

confidence: 91%

“…[10][11][12][13] The heparin albumin priming method has been established as uniform protocol since 1986 at our hospital but was only recently evaluated in a small pilot study. 14 The combined use of heparin and albumin (HA) was based on the concept of reuse of dialyzers for dialysis. 15 Thereby a protein layer covers the material of the ECC.…”

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confidence: 99%

Heparin albumin priming in a clinical setting for hemodialysis patients at risk for bleeding

Skagerlind

Stegmayr

2016

Hemodialysis International

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“…The anticoagulant activity of Hep was firstly reported by Mclean in 1916 and was confirmed by many other studies afterwards (McLean ). Currently, the LMW Hep is still the major drug for routine use in patients during hospitalization, for extracorporeal blood circulation, but also for treatment of thrombotic diseases such as venous thromboembolism (VTE) and as adjuvant therapy for atherothrombotic syndromes (Merli and Groce, ) (Fransson et al, ). Notably, LMW‐Hep, with less than 18 disaccharide units, is unable to bind thrombin and ATIII simultaneously.…”

Section: Survey On Medical Application Of Native Glycosaminoglycansmentioning

confidence: 99%

Medical application of glycosaminoglycans: a review

Köwitsch

Zhou

Groth

2017

J Tissue Eng Regen Med

182

145

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The characteristic molecular composition of the different glycosaminoglycans (GAGs) is related to their role as structural components and regulators of a multitude of functions of proteins, cells and tissues in the human body. Therefore, it is not surprising that GAGs are widely used as coating materials for implants, components of 3D-constructs such as tissue engineering scaffolds and hydrogels, but also as diagnostic devices such as biosensors and in controlled release applications. Beside a physisorption or encapsulation of GAGs, these applications often require their chemical modification to allow a stable covalent attachment on surfaces or cross-linking reactions with other molecules. Then, the preservation of the functionality of GAGs under maintenance of their biocompatibility is a challenging task and must be addressed in accordance with the designated field of application. Here, we will give a brief overview on structure and biological functions of GAGs, different methods of their activation and immobilization, the recent progress in GAG-related biomaterials development, as well as some examples of their application in the field of tissue engineering and regenerative medicine.

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“…A pharmacological heparin coating of the dialyzer and the extracorporeal circuit, without using any heparin at the start, is another option. Such method is the manual priming by perfusion of the extracorporeal circuit with a combination of heparin and albumin that is discarded before intermittent haemodialysis [ 16 , 17 ]. A prior in vitro study indicated that priming the extracorporeal circuit with only either saline or an albumin solution caused a greater risk for clotting in comparison to priming with heparin in saline or heparin and albumin in saline [ 18 ].…”

Section: Introductionmentioning

confidence: 99%

An evaluation of four modes of low-dose anticoagulation during intermittent haemodialysis

Skagerlind

Stegmayr

2017

Eur J Clin Pharmacol

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IntroductionIntensive care participants that need dialysis frequently suffer from increased risk of bleeding. Standard intermittent haemodialysis (SHD) includes anticoagulation to avoid clotting of the dialysis system. The aim of this study was to clarify which of four different low-dose anticoagulant modes was preferable in reducing the exposure to i.v. unfractionated heparin (heparin) and maintaining patency of the dialysis circuit.MethodsTwenty-three patients on SHD were included to perform haemodialysis with four modes of low-dose anticoagulation. For comparative analyses, patients served as their own control. Haemodialysis with a single bolus of tinzaparin at the start was compared to haemodialysis initiated without i.v. heparin but priming with (1) heparin in saline (H), (2) heparin and albumin in saline (HA), (3) heparin and albumin in combination with a citrate-containing dialysate (HAC), (4) saline and usinga heparin-coated filters (Evodial®). The priming fluid was discarded before dialysis started. Blood samples were collected at 0, 30 and 180 min during haemodialysis. Smaller bolus doses of heparin (500 Units/dose) were allowed during the modes to avoid interruption by clotting.FindingsThe mean activated partial thromboplastin (APTT) time as well as the doses of anticoagulation administered was highest with SHD and least with HAC and Evodial®. Mode H versus SHD had the highest rate of prematurely interrupted dialyses (33%, p = 0.008). The urea reduction rate was less with Evodial® vs. SHD (p < 0.01). One hypersensitivity reaction occurred with Evodial®. Changes in blood cell concentrations and triglycerides differed between the modes.DiscussionIf intermittent haemodialysis is necessary in patients at risk of bleeding, anticoagulation using HAC and Evodial® appeared most preferable with least administration of heparin, lowest APTT increase and lowest risk for prematurely clotted dialyzers in contrast to the least plausible H mode.Electronic supplementary materialThe online version of this article (10.1007/s00228-017-2389-x) contains supplementary material, which is available to authorized users.

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Rinsing the Extra Corporeal Circuit with a Heparin and Albumin Solution Reduces the Need for Systemic Anticoagulant in Hemodialysis

Abstract: Heparin-albumin priming resulted in a reduced total dose of heparin. There was no increased clotting and no incidence of bleeding was reported in either group.

Cited by 14 publications

References 10 publications

Heparin albumin priming in a clinical setting for hemodialysis patients at risk for bleeding

Heparin albumin priming in a clinical setting for hemodialysis patients at risk for bleeding

Medical application of glycosaminoglycans: a review

An evaluation of four modes of low-dose anticoagulation during intermittent haemodialysis

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