Überwachung der Heparintherapie bei Akutdialysen

B. Molitor; R. Klingel; G. Hafner

doi:10.1055/s-0037-1619661

Hämostaseologie, Table of Contents

Hamostaseologie 2005; 25(03): 272-278
DOI: 10.1055/s-0037-1619661

Original Article

Schattauer GmbH

Überwachung der Heparintherapie bei Akutdialysen

Monitoring of the heparin therapy during acute haemodialysis

B. Molitor

¹Hygiene-Institut des Ruhrgebietes, Gelsenkirchen

,

R. Klingel

²Apheresis Research Institute, Köln

,

G. Hafner

³Zentrum für Labormedizin und Mikrobiologie, Essen

› Author Affiliations

Abstract

Zusammenfassung

Die Antikoagulation im Rahmen einer Nierenersatztherapie ist notwendig, um die Thrombosierung der Filter zu verhindern und den Blutfluss zu erhalten. Ausnahmen bilden Patienten mit akutem Nierenversagen und Begleiterkrankungen (z. B. Sepsis, Multiorganversagen), bei denen eine drohende Blutung das extrakorporale Verfahren auch ohne Antikoagulation erfordern kann.

Am häufigsten wird unfraktioniertes Heparin als Antikoagulanz eingesetzt. Mit niedermolekularen Heparinen liegen ebenfalls positive Erfahrungen vor. Zur sicheren Therapieführung ist ein Monitoring der Antikoagulation notwendig. Die aktivierte Vollblut-Gerinnungszeit (ACT), die aktivierte partielle Thromboplastinzeit (aPTT) und die Anti-Faktor-Xa-Bestimmung mit chromogenen Substraten stehen als Routine- und Point-of-Care-Tests zur Verfügung. Zum Monitoring der niedermolekularen Heparine (NMH) kann nur die Anti-Faktor-Xa-Messung eingesetzt werden. Die spezifischste und valideste Methode für das Therapiemonitoring der Heparine ist der Anti-Faktor-Xa-Test mit Hilfe chromogener Substrate. Da wenig kontrollierte Studien zur Antikoagulanzientherapie und Monitoring mit dem Anti-Faktor-Xa-Test in der akuten Nierenersatztherapie vorliegen, beruhen die Empfehlungen auf den Erfahrungen mit der chronischen Nierenersatztherapie.

Summary

Anticoagulation during renal replacement therapy is recommended to avoid thrombosis of the filter devices and to maintain the blood flow. However, in the case of multiorgan failure and sepsis, an imminent bleeding complication in patients with acute renal failure may cause the need for an extracorporeal circulation without anticoagulation.

The most common drug used in renal replacement therapy is the unfractionated heparin (UFH). With low molecular weight heparin (LMWH) good experiences are reported, too. Based on the level of evidence from clinical studies plasma measurement of heparin is indispensable for patients with renal insufficiency. The activated whole blood clotting time (ACT), the activated partial thromboplastin time (aPTT), and the determination of the anti-factor Xa activity (anti Xa) with chromogenic substrates are available as routine as well as as point-of-care tests. To monitor plasma levels of LMWH the anti Xa assay serves exclusively as a suitable monitoring. The anti Xa assay using chromogenic substrates is the most specific and valid one for monitoring heparin therapy. In lack of large controlled studies for the anticoagulation therapy and its monitoring with the anti Xa test in acute renal failure, the current experiences are based on the results of chronic renal replacement therapy.

Schlüsselwörter

Akute Niereninsuffizienz - extrakorporales Verfahren - Antikoagulation - Heparin - Monitoring

Keywords

Acute renal failure - extracorporeal circulation - anticoagulation - heparin - monitoring

Full Text

References

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