Safety and efficacy anticoagulation by simultaneous administration of prostacyclin plus low molecular weight heparin at low-dose during extracorporeal hemodialysis

8 patients in chronic dialytic treatment were studied during hemodialysis(Hd) performed before by simultaneous infusion of low molecular weight heparin(LMWH:Seleparina)plus prostacyclin(PGI2:Flolan and after by unfractionated heparin(UFH:Liquemin). Hd was performed for 3 hours using a single pass delivery system hollow-fiber dialyzer. At beginning of Hd,LMWH at low dose(3075 IU AXa) was gived in bolus in arterial dialyzer line (inl) and PGI2 in low dosage(3 ng/Kg/min) was continuously administered in inl. UFH was continously infused in inl:at end-Hd the international unit given,ranged between 3000-4000 IU. Adequacy of anticoagulation was assessed by visual observation of the dialysis circuits for streaking in the kidney and clot formation in the venous bubble chamber on saline flush, by coagulation assays, by dialyzer clearances(Cl) for urea craetinine, phosphate and uric acid. Cl were calculated on the blood side of the dialyzer.hemodynamic parameters (blood arterial pressure/mmHg and heart rate/min) were monitored continuously. The anticoagulant regimen of low dose of PGI2 plus low dose of LMWH allowed a safe anticoagulation without affecting dialysis efficiency. There wasnʹt visual evidence of thrombosis generation in dialyzer circuit. The coagulation assays were in normal renge; also the activated partial thromboplastin time was not prolonged during all treatment with PGI2 plus LMWH. The dialyzer clearances measured at the middle (90 min) and end-Hd(180 min) were unchanged when compared th those obtained during UFH only. Never was observed hypotension or heart rate increase. In conclusion this anticoagulant regimen allows 1) to avoid the hemodynamic side effects of prostacycl in and 2) to use a lower dosage of LMWH for preventing coagulation during extracorporeal hemodialysis.