Key result
Defibrotide during hemodialysis increases PC activity and PS levels versus heparin, confirming thrombin-independent antithrombotic activity.
Why the study?
Does defibrotide alter coagulation parameters compared to heparin in uremic patients undergoing hemodialysis?
RCT (n=8)
Does defibrotide alter coagulation parameters compared to heparin in uremic patients undergoing hemodialysis?
Defibrotide demonstrates antithrombotic activity during hemodialysis that is independent of thrombin neutralization, increasing protein C activity and protein S levels.
May support defibrotide evaluation as heparin alternative in hemodialysis; hypothesis-generating and should not yet change practice.
In a crossover study conducted with eight uremic patients maintained on hemodialysis, the Authors compared the effects of heparin (100 IU/kg at the start of dialysis) and defibrotide (400 mg at the start, repeated at 2 hours of ongoing dialysis) on the parameters of blood coagulation (VIII:C, AT III, TAT, PC antigen and activity, PS, and FPA), each being assessed before dialysis and at 2, 3 and 4 hours of the ongoing procedure. Heparin-assisted dialysis resulted in a significant rise of VIII:C and AT III; with defibrotide, instead, there was evidence of thrombin activation (increased FPA and TAT). PC levels were raised with both dialysis modalities; however, PC activity and PS levels were increased only in defibrotide-assisted dialysis. There were no adverse reactions or evidence of fibrin formation. These results confirm the antithrombotic activity of defibrotide in the course of dialysis and indicate that this action is independent of thrombin neutralization.
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Filimberti et al. (1992) conducted an RCT in Uremia requiring hemodialysis (n=8). Defibrotide vs. Heparin (100 IU/kg at the start of dialysis) was evaluated on Blood coagulation parameters (VIII:C, AT III, TAT, PC antigen and activity, PS, and FPA). Defibrotide during hemodialysis increased PC activity and PS levels compared to heparin, confirming its antithrombotic activity independent of thrombin neutralization.
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