(Active Clotting Time; ACT) 131 ACT 1.2 1.3 19.14 4.65 IU/kg 8.40 2.27 IU/kg ACT (Active Clotting Time; ACT)(Anticoagulant) (Unfractional Heparin; UFH)(Heparinization) (Total bundle volume; TBV) 1% 10.8%[1] 200 240 cc 60 (08) 7368686 1622 E-mail hdr001@ptch.org.tw (Unfractional Heparin UFH ) (Antithrombin III) (heparinization) [2] (Active Clotting Time; ACT)[3] (Unfractional Heparin; UFH) (mucopolysaccha- 224 97 20 4
ride)8000 20000 (half 1ife) 40 120 III (Xa) (Prothrombin) (Thrombin) (Fibrinogen) (Fibrin) 1 (Bleeding Time) (Clotting Time) (low-molecular-weight heparin LMWH) 5000 daltons (4000 6000)(half 1ife) 4 (one bolus) (1) (2) (3) (4) (5)(6) ( ) (Xa) anti-xa anti-iia 1.5 4 (thrombin; IIa) APTT Anti-Xa ACT APTT (heparinization) 1. (systemic heparinization) (X) (Xa) ( III) (Heparin +AT III) complex (Prothrombin) (Fibrinogen) (Thrombin) 1. (Fibrin) 97 20 4 225
25 30 IU/K 1.52 (ACT 200 240 ) 5 30 min 2. (Regional heparinization) (protamine)1 mg 100 U 3. (Heparin-free method) 2500 5000 U 10 30 min 1. Activated Partial Thromboplastin Time (APTT)24 38 2. Activated Clotting Time (ACT) 110 182 ACT HEMOCHRON 801 37 C( ) [4] 700 ml 150 ml/min 1000 U ( 20 U/kg) 500 U ( 10 U/kg) 3.52 100 ml 0 10 1+ 101/3 2+ 1/31/2 3+ 1/2 4+ 10 100% ACT 1. 2. >10 3. 4. 2007 3 131 (1) Nipro H-6Polysulphone Polyamide 0 60 ACT 3049 1+ 9 (3+ )0.29% ACT (0)167.7 18.0 ACT (60) 207.3 22.4 1.2 1.3 19.1 4.6 IU/kg 8.4 2.2 IU/kg 226 97 20 4
1. ACT(n=131) Mean SD 95% 54 77 59.5 14.3 63.3 13.3 61.7 13.8 61.4 8.9 54.83 9.39 57.2 10.2 33.30 3.16 32.45 2.41 32.6 2.6 109(83.9%) 22 (16.1%) 88 (61.1%) 43 (38.9%) Polysulfone 113 (86.2%) Polyamide 18 (13.8%) ACT (0) Sec 167.73 18.04 170.85 164.61 IU/kg 19.14 4.65 19.94 18.33 ACT (60) Sec 207.32 22.48 211.21 203.43 IU/kg 8.40 2.27 8.80 8.01 ACT (60) 1.24 0.13 1.27 1.22 U/Kg 48.55 10.84 50.42 46.68 (Antithrombin ) [4] (activated partial thromboplastin time; APTT) EDTA (liquid phospholipid) 77 [5] ACT ( Kolin, glass) ACT [3,6-7]1.5 2.0 [4,7] 2008 Ward RA ACT140 180% [3] 50 IU/kg [8] [3] Heparin-free method ( ) [9] Sagedal S polysulphone 30 60 100 ml[10-11] 97 20 4 227
Lucchi L 20 5- (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 20 25 IU/kg 10 12.5 IU/kg [7] ACT(0) 167.7 18.0 ACT(60) 207.3 22.4 1.2 1.3 0.29% (Subdural hemorrhage) [17-19] ACT ACT (0) (60) ACT ACT 0.29% ACT() ACT (Erythropoietin, EPO) Hct 33 36% 18 20 IU/ kg8 9 IU/kg/hr 48.5 IU/kg1.2 1.3 ACT [20] 1. 2005 4: 25-34 2. 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: 252-7. 3. Ward RA: Heparinization for routine hemodialysis. Adv Ren Replace Ther 1995; 2: 362-70. 4. Kim YG: Anticoagulation during haemodialysis in patients at high-risk of bleeding. Nephrology (Carlton) 2003; 8: S23-7. 5. 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: 371-8. 6. 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: 15-9. 7. 2002 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: 789-95. 9. Carbone V: Heparin and dialyzer membranes during hemodialysis: a literature review. ANNA J 1995; 22: 452-5, 467. 10. Sagedal S, Hartmann A, Osnes K, Bjornsen S, Torremocha 228 97 20 4
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; 21:444-9. 11. Romao JE, Fadil MA, Sabbaga E, Marondes M: Haemodialysis without anticoagulant: haemostasis parameters, fibrinogen kinetic, and dialysis efficiency. Nephrol Dial Transplant 1997; 12: 106-10. 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: 106-10. 13. Lavaud S, Canivet E, Wuillai A, et al: Optimal anticoagulation strategy in haemodialysis with heparin-coated polyacrylonitrile membrane. Nephrol Dial Transplant 2003; 18: 2097-104. 14. 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: 987-93. 15. Kes P, Reiner Z, Starcevic B, Ratkovic-Gusic I: Influence of erythropoietin treatment on dialyzer reuse. Blood purify 1997; 15: 77-83. 16. Hofbauer R, Moser D, Frass M, et al: Effect of anticoagulation on blood membrane interactions during hemodialysis. Kidney International 1999; 56: 1578-83. 17. 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: 475-80. 18. Sonawane S, Kasbekar N, Berns JS: The safety of heparins in end-stage renal disease. Semin Dial 2006; 19: 305-10. 19. Sood P, Sinson GP, Cohen EP: Subdural hematomas in chronic dialysis patients: significant and increasing. Clin J Am Soc Nephrol 2007; 2: 956-9. 20. Jannett TC, Wise MG, Shanklin NH, Sanders PW: Adaptive control of anticoagulation during hemodialysis. Kidney International 1994; 45: 912-5. 97 20 4 229