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CARDIOVASCULAR
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Volume 3, 1998, No 3/4 |
Experience with Chronic
Extracorporal LDL Elimination Therapy Utilizing Dextrane-Sulfate
Adsorption
B. Noll, M. Just,
B. C. Simon, M. Maasberg, B. Maisch, A. Steinmetz, J. R. Schaefer
Background: There are several links between the development of CAD and lipoproteins and the blood clotting system. Extracorporal LDL-elimination utilizing dextrane-sulfate cellulose (DSC) adsorper is a frequently used procedure for lowering atherogenetic LDL-cholesterol in patients with coronary artery disease (CAD) and severe hypercholesterolemia, which cannot be treated otherwise.
Methods: We analyzed the changes of lipoproteins and blood clotting factors of three male patients prior to and after LDL-apheresis with DSC. 80 treatments were analyzed and the effect of LDL-apheresis is given.
Results: Fibrinogen (-22%), plasminogen (-24%), AT-III (-26%), factor XII (-65%), cholesterol (-49%), LDL-cholesterol (-55%), apoB (-57%), Lp (a) (-54%), HDL-cholesterol (-8%) and apoA-I (-12%) decreased, whereas thrombin-antithrombin-III-complexes (+67%) showed an increase. Within one week the blood clotting factors, lipoproteins and lipids were back to the starting levels. One patient was treated for more than 200 times with LDL-apheresis without any serious side effects. However, this subject experienced vertigo once at the end of a DSC apheresis. In all other cases extracorporal LDL elimination therapy with DSC was well tolerated without any discomfort.
Conclusion: 1) The atherogenetic lipoproteins cholesterol, LDL-cholesterol, Lp(a) and apoB were efficiently removed, whereas the vasoprotective fractions such as HDL-cholesterol and apoA-I were only mildly influenced by LDL-apheresis with DSC. 2) LDL-apheresis with DSC lowers factor XII dramatically and to a less pronounced degree fibrinogen, plasminogen and AT III. 3) The increase of Thrombin-Antithrombin-III-complexes (TAT) reflects clotting activation by LDL-apheresis. 4) LDL-apheresis with DSC is a safe and well tolerated procedure for lowering atherogenetic lipoproteins.
Key words: LDL-apheresis, dextrane sulfate cellulose, lipoproteins, blood clotting factors, factor XII
Reference:
(CVE. 1998; 3 (3/4):
167-169)
Address for Correspondence:
Bernd Noll, M.D.
Department of Internal Medicine
Cardiology, Philipps-University Marburg
D-35033 Marburg
Germany, E-mail: nollb@mailer.uni-marburg.de
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