Application Of Anti-factor Xa Activity Was Measured In Aged Patients With Long Term Hemodialysis

Objective To assess the effect of LMWH and UFH through monitoring anti-Xa activity ofaged patients with long term hemodialysis.Method1.24long term hemodialysis cases in both groups with regular venous administration ofLMWH or UFH were recruited. After drug administration, Chromogenic substrate assaywas applied to detect the anti-Xa activity of LMWH,LMWH group UFH group atdifferent time spots(1h,2h,3h,4h and24h) in plasma, identified the time spots whenanti-Xa activity peaked in both groups.2. From senior hemodialysis cases,95taking routine use of LMWH (LMWH group) and40having regular use of UFH (UFH group) were recruited in our study. Anti-Xa activity,KT/V value, HS-C reactive protein, Alb, PAB, HGB, TC, TG, HDL, LDL, Ca, P, K, ALPwere detected in serum of both groups; PLT, PCT, MPV, PDW were analyzed byhematology analyzer; PTH and β2-MG were measured by radioimmunoassay; bleedingevents and MOS SF-36scores were used to assess life quality. By comparison of indicatorsabove, the drug which is more suitable for aged patients with long term hemodialysiswould be determined.3. the LMWH group was divided into3subgroups according to anti-Xa activity: subgroupA30cases (activity<0.4IU/ml); subgroup B45cases (0.4IU/ml activity <1.0IU/ml);subgroup C20cases (activity±1.0IU/ml). KT/V value, HGB, Alb, HS-C reactive protein,TC, TG, HDL-C, LDL-C, Ca, P, were detected in serum of both groups; PTH wasmeasured by radioimmunoassay; bleeding events and MOS SF-36scores were used toassess life quality. The optimal anticoagulative range of LMWH was analyzed throughcomparison.Results1. Anti-Xa activity in both groups peaked two hours after dosed, the values are (0.81±0.24)IU/ML and (0.96±0.13) IU/ML separately. The concentrations are (0.50±0.18) IU/ml and(0.5±0.09) IU/ml when4hours after dosed namely hemodialysis ended. 2. In LMWH group and UFH group, anti-Xa activity was (0.643±0.583)IU/ml,(0.550±0.273) IU/ml separately, no difference was found(P＞0.05); values of KT/V were(1.48±0.390) for LMWH group,(1.45±0.33) for UFH group, no difference was found(P＞0.05); values of β2-MG were (30.23±9.87) mg/L for LMWH group,(36.58±3.90) mg/L forUFH group, P value was0.94; values of HS-CP were (3.79±4.78) mg/L for LMWH group,(6.998±1.566) mg/L for UFH group, P value was under0.05. HGB, Alb and prealbuminwere in normal range in both groups, no difference was found(P>0.05).TC, TG, HDL, LDL were (4.62±0.54) mmol/L,(1.62±0.34) mmol/L,(1.51±0.32) mmol/Land (2.34±0.51) mmol/L respectively in LMWH group; while in UFH group, they were(4.97±0.65) mmol/L,(2.37±0.52) mmol/L,(1.06±0.34) mmol/L and (3.52±0.26) mmol/Lrespectively. Differences were found in both groups(P<0.05).PTH and ALP were (437.21±729.44) pg/m and (28.10±85.87)mmo/L respectively inLMWH group; while in UFH group, they were (183.73±159.45) pg/ml and (97.33±20.75)mmo/L respectively. No differences were found in both groups (P>0.05), but the levelsbeyond the upper limit of healthy control. Blood phosphorus content was higher thannormal, but found no difference when compared with that of UFH group. Serum Ca and Kwere in normal range.PLT in LMWH group was160.70±45.30, PLT in UFH group was155.0±36.0, nodifference was found (P>0.05). PCT, MPV and PDW comparison in both groups showedP>0.05.Between both groups,6cases were found bleeding after hemodialysis in group A, ofwhich4showed slight bleeding,2betrayed severe bleeding, bleeding cases occupied6.3%of LMWH groups total cases; while5cases(occupied12.5%of UFH cases) were foundslight bleeding in group B. Bleeding rate of UFH group was two times of that of HMWHgroup, furthermore, the anti-Xa activity was beyond1.0IU/ml in each of bleeding cases.In the scores of MOS SF-36, LMWH group showed Physicalfunctioning,Rolelimitation-physical, Socialfunctioning and Rolelimitation-emotional with scores of(83.45±12.36),(86.78±8.07),(62.13±9.34) and (86.37±13.39) respectively; UFH groupshowed (75.43±10.36),(81.40±5.65),(59.46±7.08) and (82.31±15.53) at the same time.LMWH group scored higher than UFH group on these parameters, but without difference(P>0.05). Bodilypain scores (61.58±11.4) in LMWH group and (72.31±8.49) in UFHgroup, the difference was found(P<0.05). 3. The LMWH group was divided into3subgroups according to anti-Xa activity: subgroupA30cases (activity<0.4IU/ml); subgroup B45cases (0.4IU/ml activity <1.0IU/ml);subgroup C20cases (activity±1.0IU/ml). KT/V value of subgroup A was1.100.08,1.45±0.22for subgroup B,1.32±0.16for subgroup C. The data of B and C was higher thanA (P<0.05), while no difference was found in B and C.Subgroup A and B found no bleeding event. Subgroup C found4cases had slight bleedingwhen with epistaxis, petechia or puncture,1case found petechiae spreaded on body withpuncture spot bleeding on vein.HGB in subgroup B (128.45±12.82) g/L higher than subgroup B andC((98.57±6.43)g/L and (105.79±10.54)g/L respectively), while A and C subgroup had nodifference (P>0.05). Alb were (37.03±2.36),(42.03±3.17) and (36.91±5.39) respectivelyfor subgroup A, B and C, the trend was equal with that of HGB. HS-CRP subgroup datashowed no difference (P>0.05), but subgroup C had higher value than normal.TC, TG, HDL and LDL showed had no difference in subgroup comparisons (P>0.05).Ca, P and PTH in serum had no difference in subgroup comparisons (P>0.05), thelevels of P and PTH in serum higher than normal.Association analysis showed that antiíXa activity was positively related with KT/V,ALB and HGB; while showed negative relation with PTH.In patients with anti-Xa activity±0.4IU/ml, Physicalfunctioning, Vitality,Socialfunctioning and Mentalhealth scored higher tha tpatients with anti-Xa activity<0.4IU/ml, that is to say, B and C subgroup compared with sungroup A, difference was Conclusions1. Anti-Xa activity in both groups peaked two hours after dosed, the effectiveanticoagulation worked when after4hours on dosed.2. the effect of LMWH and UFH were similar for long term hemodialysis patients.3. dialysis adequacy were similar under the two drugs.4.Life quality was better in patients with LMWH than with UFH.5.Safe range of anti-Xa activity for long term LMWH dosed aged patients is0.4IU/ml-1.0IU/ml. 6. UFH was a choice for aged patients with imbalanced account, LMWH could improveblood lipids and inflammation, it was also recommended for it had little side effect ofbleeding.