The features of platelet function and platelet morphology by using of anticoagulant therapy in patients with chronic renal failure treated with hemodialysis

Abstract

We enrolled 25 patients at the end-stage of chronic renal failure of various origins, who were treated with program hemodialysis (PHD) in the Center of Dialysis and Transplantation at the M.F. Vladimirsky Moscow regional clinical and research institute. The main group consisted of 12 patients who were administered Fraxiparine («GlaxoSmithKline», United Kingdom), a low-molecular weight heparin for hypocoagulation during the procedure of hemodialysis. The drug was administered in a bolus dose prescribed individually into the arterial line after connecting it to a fistula needle. The control group (13 patients) received unfractionated heparin in conventional way (a bolus 2000 to 2500 IU before the beginning of the procedure, followed by 1200 to 1500 IU/h in a continuous infusion, stopped 1 hour prior to the end of dialysis). At the beginning and the end of the procedure the concentration of platelets was measured. Morphofunctional state of living platelets in situ we evaluated by the method of computer morphometry using computer phase-interference microscope (CPM) «Cytoscan» (Moscow, Russia). We analyzed the optical - geometrical parameters and the morphological features of living platelets which reflected the degree of their activation at the beginning of PHD (before administration of heparin), in 15 minutes after it and at the end of the procedure. After the hemodialysis we registered the certain changes of the morphological content and optical (geometrical) parameters of circulating platelets which changed in the different degree depending on prescribed anticoagulant therapy. The results allow us to conclude that the use of Fraxiparine provides better ratio of efficacy/safety and causes a reduction of the platelet activation during the hemodialysis procedure.