(Active Clotting Time; ACT) (Anticoagulant)

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1 (Active Clotting Time; ACT) 131 ACT IU/kg IU/kg ACT (Active Clotting Time; ACT)(Anticoagulant) (Unfractional Heparin; UFH)(Heparinization) (Total bundle volume; TBV) 1% 10.8%[1] cc 60 (08) (Unfractional Heparin UFH ) (Antithrombin III) (heparinization) [2] (Active Clotting Time; ACT)[3] (Unfractional Heparin; UFH) (mucopolysaccha

2 ride) (half 1ife) III (Xa) (Prothrombin) (Thrombin) (Fibrinogen) (Fibrin) 1 (Bleeding Time) (Clotting Time) (low-molecular-weight heparin LMWH) 5000 daltons ( )(half 1ife) 4 (one bolus) (1) (2) (3) (4) (5)(6) ( ) (Xa) anti-xa anti-iia (thrombin; IIa) APTT Anti-Xa ACT APTT (heparinization) 1. (systemic heparinization) (X) (Xa) ( III) (Heparin +AT III) complex (Prothrombin) (Fibrinogen) (Thrombin) 1. (Fibrin)

3 25 30 IU/K 1.52 (ACT ) 5 30 min 2. (Regional heparinization) (protamine)1 mg 100 U 3. (Heparin-free method) U min 1. Activated Partial Thromboplastin Time (APTT) Activated Clotting Time (ACT) ACT HEMOCHRON C( ) [4] 700 ml 150 ml/min 1000 U ( 20 U/kg) 500 U ( 10 U/kg) ml /3 2+ 1/31/2 3+ 1/ % ACT > (1) Nipro H-6Polysulphone Polyamide 0 60 ACT (3+ )0.29% ACT (0) ACT (60) IU/kg IU/kg

4 1. ACT(n=131) Mean SD 95% (83.9%) 22 (16.1%) 88 (61.1%) 43 (38.9%) Polysulfone 113 (86.2%) Polyamide 18 (13.8%) ACT (0) Sec IU/kg ACT (60) Sec IU/kg ACT (60) U/Kg (Antithrombin ) [4] (activated partial thromboplastin time; APTT) EDTA (liquid phospholipid) 77 [5] ACT ( Kolin, glass) ACT [3,6-7] [4,7] 2008 Ward RA ACT % [3] 50 IU/kg [8] [3] Heparin-free method ( ) [9] Sagedal S polysulphone ml[10-11]

5 Lucchi L (Thrombin-antithrombin; TAT) Heparin (2500 IU/L) [12] [4,9,13]β - (β-thromboglobulin β-tg) [14] (Total bundle volume; TBV) Kes P heparin [15] [16] Heparin IU/kg IU/kg [7] ACT(0) ACT(60) % (Subdural hemorrhage) [17-19] ACT ACT (0) (60) ACT ACT 0.29% ACT() ACT (Erythropoietin, EPO) Hct 33 36% IU/ kg8 9 IU/kg/hr 48.5 IU/kg ACT [20] : Chanard J, Lavaud S, Randoux C, Rieu P: New insights in dialysis membrane biocompatibility: relevance of adsorption properties and heparin binding. Nephrol Dial Transplant 2003; 18: Ward RA: Heparinization for routine hemodialysis. Adv Ren Replace Ther 1995; 2: Kim YG: Anticoagulation during haemodialysis in patients at high-risk of bleeding. Nephrology (Carlton) 2003; 8: S Solomon HM, Mullins RE, Lvden P, Thompson P, Hudoff S: The diagnostic accuracy of bedside and laboratory coagulation: procedures used to monitor the anticoagulation status of patients treated with heparin. Am J Clin Pathol 1998; 109: Greiber S, Weber U, Galle J, Bramer P, Schollmeyer P: Activated clotting time is not a sensitive parameter to monitor anticoagulation with low molecular weight heparin in hemodialysis. Nephron 1997; 76: P89 8. Brunet P, Simon N, Opris A, et al: Pharmacodynamics of unfractionated heparin during and after a hemodialysis session. Am J Kidney Dis 2008; 51: Carbone V: Heparin and dialyzer membranes during hemodialysis: a literature review. ANNA J 1995; 22: 452-5, Sagedal S, Hartmann A, Osnes K, Bjornsen S, Torremocha

6 J, Johan K, Brosstad F: Intermittent saline flushes during haemodialysis do not alleviate coagulation and clot formation in stable patients receiving reduced dose of dalteparin. Nephrol Dial Transplant 2006; 21: Romao JE, Fadil MA, Sabbaga E, Marondes M: Haemodialysis without anticoagulant: haemostasis parameters, fibrinogen kinetic, and dialysis efficiency. Nephrol Dial Transplant 1997; 12: Lucchi L, Ligabue G, Marietta M, et al: Activation of coagulation during hemodialysis: effect of blood lines alone and whole extracorporeal circuit. Artif Organs 2006; 30: Lavaud S, Canivet E, Wuillai A, et al: Optimal anticoagulation strategy in haemodialysis with heparin-coated polyacrylonitrile membrane. Nephrol Dial Transplant 2003; 18: Sagedal S, Hartmann A, Sundstrom K, Bjornsen S, Brosstad F: Anticoagulation intensity sufficient for haemodialysis does not prevent activation of coagulation and platelets. Nephrol Dial Transplant 2001; 16: Kes P, Reiner Z, Starcevic B, Ratkovic-Gusic I: Influence of erythropoietin treatment on dialyzer reuse. Blood purify 1997; 15: Hofbauer R, Moser D, Frass M, et al: Effect of anticoagulation on blood membrane interactions during hemodialysis. Kidney International 1999; 56: Sougiyyeh MZ, Shaheen FA: Attitude of physicians in Saudi Arabia towards heparin administration and monitoring in hemodialysis patients. Saudi J Kidney Dis Transpl 2003; 14: Sonawane S, Kasbekar N, Berns JS: The safety of heparins in end-stage renal disease. Semin Dial 2006; 19: Sood P, Sinson GP, Cohen EP: Subdural hematomas in chronic dialysis patients: significant and increasing. Clin J Am Soc Nephrol 2007; 2: Jannett TC, Wise MG, Shanklin NH, Sanders PW: Adaptive control of anticoagulation during hemodialysis. Kidney International 1994; 45:

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