Hemodialysis with Defibrotide: Effects on Coagulation Parameters

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.

Defibrotide: a review on clinical use and future development

BACKGROUND

Defibrotide is a deoxyribonucleic acid derivative that has been developed for the treatment of different vascular disorders.

OBJECTIVE

The authors reviewed the literature to give due representation to the spectrum of pharmacological properties and clinical application of this drug, evaluating consolidate and innovative application.

METHODS

The authors used PubMed from November 1982 to December 2007 and meeting abstracts (form American Society of Hematology Annual Meeting) with updated data as the sources for this review and selecting the most relevant papers when two or more articles covered the same point of interest.

CONCLUSIONS

Defibrotide has been used effectively in the treatment of endothelial complications of allogeneic stem cell transplantation and recent preclinical evidences suggest an antiangiogenic effect and an anticancer activity. Further in vivo and in vitro investigations are needed.

The approach to anticoagulation in patients treated with extracorporeal therapy in the intensive care unit

No wholly satisfactory drug or system has yet been devised for preventing thrombosis in extracorporeal blood circuits needed for renal replacement treatments. Heparin is still regarded by some as a standard approach, but advances in many areas of intensive care unit (ICU) medicine have created the potential for saving the lives of many patients in whom heparin anticoagulation is no longer appropriate. Several nonheparin methods are now readily performed, and the great risk of bleeding that is imposed by the use of heparin demands that citrate or other nonheparin methods be made available in the ICUs of all major medical centers that deal with trauma or major surgical procedures. Details of the practicalities, difficulties, and advantages are compared for low-dose heparin, regional heparin, low-molecular-weight heparin, no-anticoagulant systems, citrate, and other anticoagulants for both intermittent and continuous modalities. The clinical features and complications in individual patients that impact on the selection of the best method of management are reviewed.