Key result
Lipid apheresis options expand with emerging Lp(a) immunoadsorption and LDL hemoperfusion techniques.
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Currently, 5 different lipid apheresis procedures are available for routine clinical treatment of hypercholesterolemic patients. Unselective plasma exchange is a technically simple extracorporeal circuit, but albumin substitution fluid must be used and there is no high-density lipoprotein (HDL) recovery. Semiselective double filtration with improved size selectivity because of a small-pore secondary filter combines good elimination of low-density lipoprotein (LDL), lipoprotein (a) (Lp[a]), and fibrinogen with adequate HDL recovery; modifications such as thermofiltration, predilution/backflush, or pulsatile flow have been proposed for the improvement of this system. Three highly selective procedures are based on immunologic or electrostatic interactions: immunoadsorption using anti-low-density lipoprotein (LDL) antibodies, chemoadsorption onto dextran sulfate, and heparin-induced LDL precipitation (HELP) apheresis. The features of each system are discussed critically. Lastly, two new developments, Lp(a) immunoadsorption and LDL hemoperfusion using a polyacrylate LDL adsorber compatible with whole blood, are described.
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Thomas Bosch (1996) conducted a review in Hypercholesterolemia. Lipid apheresis (plasma exchange, double filtration, immunoadsorption, dextran sulfate chemoadsorption, HELP apheresis, Lp(a) immunoadsorption, and LDL hemoperfusion) was evaluated. Five routine lipid apheresis procedures and two new developments (Lp(a) immunoadsorption and polyacrylate LDL hemoperfusion) are reviewed for hypercholesterolemic patients.
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