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Effects of dermatan sulfate for anticoagulation in continuous renal replacement therapy.
J Nephrol. 2008 Mar-Apr; 21(2):205-12.JN

Abstract

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.

Authors+Show Affiliations

Vitale C
Nephrology and Dialysis Unit, ASO Ordine Mauriziano, Torino, Italy. covitale@libero.it
Verdecchia C
No affiliation info available
Bagnis C
No affiliation info available
Ganzaroli M
No affiliation info available
Giorcelli G
No affiliation info available
Marangella M
No affiliation info available

MeSH

Acute Kidney InjuryAgedAnticoagulantsCardiovascular Surgical ProceduresDermatan SulfateFemaleHemodiafiltrationHeparin, Low-Molecular-WeightHumansInfusions, IntravenousInjections, IntravenousMalePartial Thromboplastin Time

Pub Type(s)

Journal Article

Language

eng

PubMed ID

18446715

Citation

Vitale, Corrado, et al. "Effects of Dermatan Sulfate for Anticoagulation in Continuous Renal Replacement Therapy." Journal of Nephrology, vol. 21, no. 2, 2008, pp. 205-12.
Vitale C, Verdecchia C, Bagnis C, et al. Effects of dermatan sulfate for anticoagulation in continuous renal replacement therapy. J Nephrol. 2008;21(2):205-12.
Vitale, C., Verdecchia, C., Bagnis, C., Ganzaroli, M., Giorcelli, G., & Marangella, M. (2008). Effects of dermatan sulfate for anticoagulation in continuous renal replacement therapy. Journal of Nephrology, 21(2), 205-12.
Vitale C, et al. Effects of Dermatan Sulfate for Anticoagulation in Continuous Renal Replacement Therapy. J Nephrol. 2008 Mar-Apr;21(2):205-12. PubMed PMID: 18446715.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effects of dermatan sulfate for anticoagulation in continuous renal replacement therapy. AU - Vitale,Corrado, AU - Verdecchia,Claudio, AU - Bagnis,Cristiana, AU - Ganzaroli,Marco, AU - Giorcelli,Giovanni, AU - Marangella,Martino, PY - 2008/5/1/pubmed PY - 2008/8/30/medline PY - 2008/5/1/entrez SP - 205 EP - 12 JF - Journal of nephrology JO - J Nephrol VL - 21 IS - 2 N2 - 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. SN - 1121-8428 UR - https://www.unboundmedicine.com/medline/citation/18446715/Effects_of_dermatan_sulfate_for_anticoagulation_in_continuous_renal_replacement_therapy_ DB - PRIME DP - Unbound Medicine ER -