血液浄化療法と抗凝固薬

概要

論文の詳細を見る
As one of the in vivo defense mechanisms blood aggregates when it comes into contact with artificial materials. Therefore, the use of anticoagulants is indispensable to extracorporeal circulation therapy, such as plasma treatment methods. For patients receiving plasma treatment therapy, it is hard to administer anticoagulants because ot their clinical conditions. In addition, extracorporeal circulation therapy accelerates blood aggregation. Mechanisms of blood coagulation include intrinsic and extrinic systems as well as coagulator functions of platelets. Outcomes of plasma treatment therapy and responses of patients receiving the therapy are affected by administered drugs, replacement fluids, membrane separators and other materials required for treatment. Anticoagulants available for such patients include heparin, protease inhibitors and sodium citrate. An anticoagulant to be selected and its dosage are determined by bleeding, replacement fluid and extracorporeal circulation volume. The dose of an anticoagulant can be reduced when fresh frozen plasma, but not albumin-containing fluid, is available during plasma exchange. Compared with the plasma exchange, the dose of an anticoagulant can be further reduced in double-filtration plasmapheresis since plasma is returned to the body after being circulated. Heparin is contraindicated for patients prescription ACE in the case of LDL. Nafamostat mesilate (NM) should be used in such cases, since it has an inhibitory effect on the activation of the kallikrein-kinin system. Platelets are activated in the presence of heparin during leukocytapheresis, since they are trapped in a column. The use of NM is, therefore, inevitable. In this case, a low dose of NM, 10-20 mg/h, is sufficient as blood flow rates for treatment are also low. Heparin has been mainly used for plasma treatment therapy. NM is given to patients with a hemorrhagic focus, since heparin has a promoting effect in bleeding tendency. Anticoagulation therapy using heparin with a platelet-activating action or NM with an inhibitory effect of bradykinin production has now become a clinical standard.
日本アフェレシス学会の論文
1999-02-28

血液浄化療法と抗凝固薬

スポンサーリンク

概要

著者

関連論文

スポンサーリンク