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Evaluation with micro-CT of different anticoagulation strategies during hemodialysis in patients with thrombocytopenia : a randomized cross-over study

Floris Vanommeslaeghe (UGent) , Filip De Somer (UGent) , Iván Josipovic (UGent) , Matthieu Boone (UGent) , Annemieke Dhondt (UGent) , Wim Van Biesen (UGent) and Sunny Eloot (UGent)
(2019) ARTIFICIAL ORGANS. 43(8). p.756-763
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Abstract
In patients with enhanced risk for bleeding, heparin-free hemodialysis (HD) with conventional dialyzers is routinely used. To explore the potential benefit of using heparin-coated dialyzers, we used a reference CT-scanning technique and registered different clotting parameters to quantify coagulation with heparin-coated versus non-coated dialyzers. Six HD patients with thrombocytopenia were dialyzed 240min in a randomized cross-over study with Evodial 1.3 or FX600 Cordiax, each without anticoagulation. Blood samples were taken from the vascular access predialysis, and from the dialyzer inlet and outlet at 5 and 240min after dialysis start. Predialysis blood samples were analyzed for hemoglobin, hematocrit, thrombocytes, fibrinogen, and activated partial thromboplastin time. On dialyzer inlet and outlet blood samples, a viscoelastic measurement of blood coagulation was performed using a Sonoclot analyzer. After dialysis, dialyzers were visually scored, subsequently dried for 24h, weighed, and scanned with micro-CT at a resolution of 25μm. After image reconstruction, the open, non-coagulated fibers were counted in a representative cross-section at the dialyzer outlet. No sessions were terminated prematurely for circuit clotting. Heparin-coated dialyzers had more patent fibers on micro-CT versus non-coated dialyzers and also had a better score of subjective visual assessment of fiber clotting. There was no difference in subjective assessment of clotting at the venous drip chamber. With both dialyzers, all ACT values remained in the normal range, and were lower at the dialyzer outlet versus inlet. In conclusion, dialysis with a heparin-coated versus non heparin-coated membrane results in substantially less coagulated fibers during 4 hours hemodialysis without systemic anticoagulation. Eventual leaching of heparin, immobilized on the fiber membrane, does not result in measurable systemic anticoagulation. This article is protected by copyright. All rights reserved.
Keywords
anticoagulation, bleeding disorder, fiber blocking, fiber patency, hemodialysis, heparin-coated, HEPARIN-BINDING, MEMBRANE, DIALYSIS, AN69ST

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MLA
Vanommeslaeghe, Floris, et al. “Evaluation with Micro-CT of Different Anticoagulation Strategies during Hemodialysis in Patients with Thrombocytopenia : A Randomized Cross-over Study.” ARTIFICIAL ORGANS, vol. 43, no. 8, 2019, pp. 756–63.
APA
Vanommeslaeghe, F., De Somer, F., Josipovic, I., Boone, M., Dhondt, A., Van Biesen, W., & Eloot, S. (2019). Evaluation with micro-CT of different anticoagulation strategies during hemodialysis in patients with thrombocytopenia : a randomized cross-over study. ARTIFICIAL ORGANS, 43(8), 756–763.
Chicago author-date
Vanommeslaeghe, Floris, Filip De Somer, Iván Josipovic, Matthieu Boone, Annemieke Dhondt, Wim Van Biesen, and Sunny Eloot. 2019. “Evaluation with Micro-CT of Different Anticoagulation Strategies during Hemodialysis in Patients with Thrombocytopenia : A Randomized Cross-over Study.” ARTIFICIAL ORGANS 43 (8): 756–63.
Chicago author-date (all authors)
Vanommeslaeghe, Floris, Filip De Somer, Iván Josipovic, Matthieu Boone, Annemieke Dhondt, Wim Van Biesen, and Sunny Eloot. 2019. “Evaluation with Micro-CT of Different Anticoagulation Strategies during Hemodialysis in Patients with Thrombocytopenia : A Randomized Cross-over Study.” ARTIFICIAL ORGANS 43 (8): 756–763.
Vancouver
1.
Vanommeslaeghe F, De Somer F, Josipovic I, Boone M, Dhondt A, Van Biesen W, et al. Evaluation with micro-CT of different anticoagulation strategies during hemodialysis in patients with thrombocytopenia : a randomized cross-over study. ARTIFICIAL ORGANS. 2019;43(8):756–63.
IEEE
[1]
F. Vanommeslaeghe et al., “Evaluation with micro-CT of different anticoagulation strategies during hemodialysis in patients with thrombocytopenia : a randomized cross-over study,” ARTIFICIAL ORGANS, vol. 43, no. 8, pp. 756–763, 2019.
@article{8609663,
  abstract     = {In patients with enhanced risk for bleeding, heparin-free hemodialysis (HD) with conventional dialyzers is routinely used. To explore the potential benefit of using heparin-coated dialyzers, we used a reference CT-scanning technique and registered different clotting parameters to quantify coagulation with heparin-coated versus non-coated dialyzers. Six HD patients with thrombocytopenia were dialyzed 240min in a randomized cross-over study with Evodial 1.3 or FX600 Cordiax, each without anticoagulation. Blood samples were taken from the vascular access predialysis, and from the dialyzer inlet and outlet at 5 and 240min after dialysis start. Predialysis blood samples were analyzed for hemoglobin, hematocrit, thrombocytes, fibrinogen, and activated partial thromboplastin time. On dialyzer inlet and outlet blood samples, a viscoelastic measurement of blood coagulation was performed using a Sonoclot analyzer. After dialysis, dialyzers were visually scored, subsequently dried for 24h, weighed, and scanned with micro-CT at a resolution of 25μm. After image reconstruction, the open, non-coagulated fibers were counted in a representative cross-section at the dialyzer outlet. No sessions were terminated prematurely for circuit clotting. Heparin-coated dialyzers had more patent fibers on micro-CT versus non-coated dialyzers and also had a better score of subjective visual assessment of fiber clotting. There was no difference in subjective assessment of clotting at the venous drip chamber. With both dialyzers, all ACT values remained in the normal range, and were lower at the dialyzer outlet versus inlet. In conclusion, dialysis with a heparin-coated versus non heparin-coated membrane results in substantially less coagulated fibers during 4 hours hemodialysis without systemic anticoagulation. Eventual leaching of heparin, immobilized on the fiber membrane, does not result in measurable systemic anticoagulation. This article is protected by copyright. All rights reserved.},
  author       = {Vanommeslaeghe, Floris and De Somer, Filip and Josipovic, Iván and Boone, Matthieu and Dhondt, Annemieke and Van Biesen, Wim and Eloot, Sunny},
  issn         = {0160-564X},
  journal      = {ARTIFICIAL ORGANS},
  keywords     = {anticoagulation,bleeding disorder,fiber blocking,fiber patency,hemodialysis,heparin-coated,HEPARIN-BINDING,MEMBRANE,DIALYSIS,AN69ST},
  language     = {eng},
  number       = {8},
  pages        = {756--763},
  title        = {Evaluation with micro-CT of different anticoagulation strategies during hemodialysis in patients with thrombocytopenia : a randomized cross-over study},
  url          = {http://dx.doi.org/10.1111/aor.13452},
  volume       = {43},
  year         = {2019},
}

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