vtioВестник трансплантологии и искусственных органовRussian Journal of Transplantology and Artificial Organs1995-1191Academician V.I.Shumakov National Medical Research Center of Transplantology and Artificial Organs", Ministry of Health of the Russian Federation10.15825/1995-1191-2010-4-80-85vtio-348Research ArticleОбзор литературыLiterature ReviewsАНТИКОАГУЛЯЦИЯ ПРИ ЗАМЕСТИТЕЛЬНОЙ ПОЧЕЧНОЙ ТЕРАПИИ: КЛАССИЧЕСКИЕ ПОДХОДЫ И НОВЫЕ ВОЗМОЖНОСТИCLOTTING PREVENTION IN RENAL REPLACEMENT THERAPY: CLASSICAL APPROACHES AND NEW OPPORTUNITIESСтроковА. Г.StrokovA. G.medick@bk.ruПозЯ. Л.PozY. L.ФГУ «Федеральный научный центр трансплантологии и искусственных органов имени академика В.И. Шумакова» Минздравсоцразвития РФ, МоскваРоссияAcademician V.I. Shumakov Federal Research Center of Transplantology and Artificial OrgansRussian Federation201009062014124ВЕСТНИК ТРАНСПЛАНТОЛОГИИ И ИСКУССТВЕННЫХ ОРГАНОВ том XII No 4–20108085Copyright © Строков А.Г., Поз Я.Л., 20102010Строков А.Г., Поз Я.Л.Strokov A.G., Poz Y.L.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.transpl.ru/vtio/article/view/348

Применение антикоагулянтов является одним из ключевых моментов при заместительной почечной те- рапии. В данном обзоре литературы рассмотрены традиционная гепаринизация и ее осложнения, низко- молекулярные гепарины, широко применяющиеся в программном гемодиализе, безгепариновый диализ, регионарная цитратная антикоагуляция, а также современные альтернативные антикоагулянты. 

Clotting prevention is one of the key problems in renal replacement therapy. In this review traditional heparini- zation and its complications, low molecular weight heparins, which are wide used in programme haemodialysis, treatment without anticoagulants, regional citrate anticoagulantion, as well as new alternative anticoagulants are considered. 

антикоагуляциягепариннизкомолекулярные гепариныгемодиализзаместительная почечная терапия.anticoagulantionheparinlow molecular weight heparinshaemodialysisrenal replacement therapy.ReferencesШило В.Ю. Низкомолекулярные гепарины в гемоди- ализе: многолетний опыт применения далтепарина // Клиницист. 2008. Vol. 2. P. 55–61.Шило В.Ю. Низкомолекулярные гепарины в гемоди- ализе: многолетний опыт применения далтепарина // Клиницист. 2008. Vol. 2. P. 55–61.Bagshaw S.M., Laupland K.B., Boiteau P.J., Godinez- Luna T. Is regional citrate superior to systemic heparin anticoagulation for continuous renal replacement thera- py? A prospective observational study in an adult regi- onal critical care system // J. Crit. Care. 2005. Vol. 20. P. 155–161.Bagshaw S.M., Laupland K.B., Boiteau P.J., Godinez- Luna T. Is regional citrate superior to systemic heparin anticoagulation for continuous renal replacement thera- py? A prospective observational study in an adult regi- onal critical care system // J. Crit. Care. 2005. Vol. 20. P. 155–161.Bakker A.J., Boerma E.C., Keidel H., Kingma P., van der Voort P.H. Detection of citrate overdose in critically ill patients on citrate-anticoagulated venovenous haemofil- tration: use of ionised and total/ionised calcium // Clin. Chem. Lab. Med. 2006. Vol. 44. P. 962–966.Bakker A.J., Boerma E.C., Keidel H., Kingma P., van der Voort P.H. Detection of citrate overdose in critically ill patients on citrate-anticoagulated venovenous haemofil- tration: use of ionised and total/ionised calcium // Clin. Chem. Lab. Med. 2006. Vol. 44. P. 962–966.Bernieh B., Boobes Y., Al Hakim M.R. et al. Long-term use of low-molecular-weight heparin in hemodialy- sis patients: a 7-year experience // Blood Purif. 2009. Vol. 27 (3). P. 242–245.Bernieh B., Boobes Y., Al Hakim M.R. et al. Long-term use of low-molecular-weight heparin in hemodialy- sis patients: a 7-year experience // Blood Purif. 2009. Vol. 27 (3). P. 242–245.Brunet P., Simon N., Opris A. et al. Pharmacodynamics of unfractionated heparin during and after a hemodi- alysis session // Am. J. Kidney Dis. 2008. Vol. 51 (5). P. 789–795.Brunet P., Simon N., Opris A. et al. Pharmacodynamics of unfractionated heparin during and after a hemodi- alysis session // Am. J. Kidney Dis. 2008. Vol. 51 (5). P. 789–795.Burry L.D., Tung D.D., Hallett D. et al. Regional citrate anticoagulation for PrismaFlex continuous renal repla- cement therapy // Ann Pharmacother. 2009. Vol. 43 (9). P. 1419–1425.Burry L.D., Tung D.D., Hallett D. et al. Regional citrate anticoagulation for PrismaFlex continuous renal repla- cement therapy // Ann Pharmacother. 2009. Vol. 43 (9). P. 1419–1425.Chanard J., Lavaud S., Maheut H. et al. The clinical evaluation of low-dose heparin in haemodialysis: a pro- spective study using the heparin-coated AN69 ST mem- brane // Nephrol. Dial. Transplant. 2008. Vol. 23 (6). P. 2003–2009.Chanard J., Lavaud S., Maheut H. et al. The clinical evaluation of low-dose heparin in haemodialysis: a pro- spective study using the heparin-coated AN69 ST mem- brane // Nephrol. Dial. Transplant. 2008. Vol. 23 (6). P. 2003–2009.Chanard J., Lavaud S., Randoux C., Rieu P. New in- sights in dialysis membrane biocompatibility: relevance of adsorption properties and heparin binding // Nephrol. Dial. Transplant. 2003. Vol. 18. P. 252–257.Chanard J., Lavaud S., Randoux C., Rieu P. New in- sights in dialysis membrane biocompatibility: relevance of adsorption properties and heparin binding // Nephrol. Dial. Transplant. 2003. Vol. 18. P. 252–257.Charif R., Davenport A. Heparin-induced thrombocy- topenia: An uncommon but serious complication of he- parin use in renal replacement therapy // Hemodial. Int. 2006. Vol. 10. P. 235–240.Charif R., Davenport A. Heparin-induced thrombocy- topenia: An uncommon but serious complication of he- parin use in renal replacement therapy // Hemodial. Int. 2006. Vol. 10. P. 235–240.Davenport A. Review article: Low-molecular-weight heparin as an alternative anticoagulant to unfractiona- ted heparin for routine outpatient haemodialysis treat- ments // Nephrology. 2009. Vol. 14. P. 455–461.Davenport A. Review article: Low-molecular-weight heparin as an alternative anticoagulant to unfractiona- ted heparin for routine outpatient haemodialysis treat- ments // Nephrology. 2009. Vol. 14. P. 455–461.Douketis J., Cook D., Meade M. et al. Prophylaxis against deep vein thrombosis in critically ill patients with severe renal insufficiency with the low-molecular- weight heparin dalteparin. An assessment of safety and pharmacodynamics: the DIRECT study // Arch Intern Med. 2008. Vol. 168 (16). P. 1805–1812.Douketis J., Cook D., Meade M. et al. Prophylaxis against deep vein thrombosis in critically ill patients with severe renal insufficiency with the low-molecular- weight heparin dalteparin. An assessment of safety and pharmacodynamics: the DIRECT study // Arch Intern Med. 2008. Vol. 168 (16). P. 1805–1812.European Best Practice Guidelines // Nephrol. Dial. Transplant. 2002. Vol. 17 (Suppl. 7). P. 63.European Best Practice Guidelines // Nephrol. Dial. Transplant. 2002. Vol. 17 (Suppl. 7). P. 63.Evenepoel P., Dejagere T., Verhamme P. et al. Heparin- coated polyacrylonitrile membrane versus regional citrate anticoagulation: a prospective randomized study of 2 anticoagulation strategies in patients at risk of blee- ding // Am. J. Kidney Dis. 2007. Vol. 49 (5). P. 642–649.Evenepoel P., Dejagere T., Verhamme P. et al. Heparin- coated polyacrylonitrile membrane versus regional citrate anticoagulation: a prospective randomized study of 2 anticoagulation strategies in patients at risk of blee- ding // Am. J. Kidney Dis. 2007. Vol. 49 (5). P. 642–649.Frank R.D., Müller U., Lanzmich R. et al. Anticoagulant- free Genius haemodialysis using low molecular weight heparin-coated circuits // Nephrol. Dial. Transplant. 2006. Vol. 21 (4). P. 1013–1018.Frank R.D., Müller U., Lanzmich R. et al. Anticoagulant- free Genius haemodialysis using low molecular weight heparin-coated circuits // Nephrol. Dial. Transplant. 2006. Vol. 21 (4). P. 1013–1018.Geerts W.H., Bergqvist D., Pineo G.F. et al. Prevention of venous thromboembolism: American college of chest physicians evidence-based clinical practice guidelines (8th Edition) // Chest. 2008. Vol. 133. S. 381–453.Geerts W.H., Bergqvist D., Pineo G.F. et al. Prevention of venous thromboembolism: American college of chest physicians evidence-based clinical practice guidelines (8th Edition) // Chest. 2008. Vol. 133. S. 381–453.Greaves M. Limitations of the laboratory monitoring of heparin therapy. Scientific and Standardization Com- mittee Communications: on behalf of the Control of Anticoagulation Subcommittee of the Scientific and Standardization Committee of the International Society of Thrombosis and Haemostasis // Thromb. Haemost. 2002. Vol. 87. P. 163–164.Greaves M. Limitations of the laboratory monitoring of heparin therapy. Scientific and Standardization Com- mittee Communications: on behalf of the Control of Anticoagulation Subcommittee of the Scientific and Standardization Committee of the International Society of Thrombosis and Haemostasis // Thromb. Haemost. 2002. Vol. 87. P. 163–164.Hursting M.J., Murray P.T. Argatroban anticoagulation in renal dysfunction: a literature analysis // Nephron. Clin. Pract. 2008. Vol. 109 (2). P. 80–94.Hursting M.J., Murray P.T. Argatroban anticoagulation in renal dysfunction: a literature analysis // Nephron. Clin. Pract. 2008. Vol. 109 (2). P. 80–94.Kalicki R.M., Aregger F., Alberio L. et al. Use of the pentasaccharide fondaparinux as an anticoagulant during haemodialysis // Thromb. Haemost. 2007. Vol. 98 (6). P. 1200–1207.Kalicki R.M., Aregger F., Alberio L. et al. Use of the pentasaccharide fondaparinux as an anticoagulant during haemodialysis // Thromb. Haemost. 2007. Vol. 98 (6). P. 1200–1207.Kodras K., Benesch T., Neumann I., Haas M. Compa- rison of two dialysers (AN69ST vs. FX100) for hepa- rin-free dialysis in patients with oral anticoagulation // Blood Purif. 2008. Vol. 26 (3). P. 226–230.Kodras K., Benesch T., Neumann I., Haas M. Compa- rison of two dialysers (AN69ST vs. FX100) for hepa- rin-free dialysis in patients with oral anticoagulation // Blood Purif. 2008. Vol. 26 (3). P. 226–230.Kozik-Jaromin J., Nier V., Heemann U. et al. Citrate pharmacokinetics and calcium levels during high-flux dialysis with regional citrate anticoagulation // Nephrol. Dial. Transplant. 2009. Vol. 24 (7). P. 2244–2251.Kozik-Jaromin J., Nier V., Heemann U. et al. Citrate pharmacokinetics and calcium levels during high-flux dialysis with regional citrate anticoagulation // Nephrol. Dial. Transplant. 2009. Vol. 24 (7). P. 2244–2251.Lai K.N., Ho K., Cheung R.C. et al. Effect of low mole- cular weight heparin on bone metabolism and hyperlipi- daemia in patients on maintenance haemodialysis // Int. J. Artif. Organs. 2001. Vol. 24. P. 447–455.Lai K.N., Ho K., Cheung R.C. et al. Effect of low mole- cular weight heparin on bone metabolism and hyperlipi- daemia in patients on maintenance haemodialysis // Int. J. Artif. Organs. 2001. Vol. 24. P. 447–455.Lim W., Cook D.J., Crowther M.A. Safety and efficacy of low molecular weight heparins for hemodialysis in patients with end-stage renal failure: a meta-analysis of randomized trials // J. Am. Soc. Nephrol. 2004. Vol. 15. P. 3192–3206.Lim W., Cook D.J., Crowther M.A. Safety and efficacy of low molecular weight heparins for hemodialysis in patients with end-stage renal failure: a meta-analysis of randomized trials // J. Am. Soc. Nephrol. 2004. Vol. 15. P. 3192–3206.Lobo B.L. Use of newer anticoagulants in patients with chronic kidney disease // Am. J. Health Syst. Pharm. 2007. Vol. 64 (19). P. 2017–2026.Lobo B.L. Use of newer anticoagulants in patients with chronic kidney disease // Am. J. Health Syst. Pharm. 2007. Vol. 64 (19). P. 2017–2026.Martel N., Lee J., Wells P.S. Risk for heparin-induced thrombocytopenia with unfractionated heparin and low-Martel N., Lee J., Wells P.S. Risk for heparin-induced thrombocytopenia with unfractionated heparin and low-molecular-weight heparin thromboprophylaxis: a meta-molecular-weight heparin thromboprophylaxis: a meta-analysis // Blood. 2005. Vol. 106. P. 2710–2715.analysis // Blood. 2005. Vol. 106. P. 2710–2715.Matsuo T., Wanaka K. Management of uremic pati- ents with heparin-induced thrombocytopenia requiring hemodialysis // Clin. Appl. Thromb. Hemost. 2008. Vol. 14 (4). P. 459–464.Matsuo T., Wanaka K. Management of uremic pati- ents with heparin-induced thrombocytopenia requiring hemodialysis // Clin. Appl. Thromb. Hemost. 2008. Vol. 14 (4). P. 459–464.Morgera S., Schneider M., Slowinski T. et al. A safe citrate anticoagulation protocol with variable treatment ef- ficacy and excellent control of the acid-base status // Crit Care Med. 2009. Vol. 37 (6). P. 2018–2024.Morgera S., Schneider M., Slowinski T. et al. A safe citrate anticoagulation protocol with variable treatment ef- ficacy and excellent control of the acid-base status // Crit Care Med. 2009. Vol. 37 (6). P. 2018–2024.Oudemans-van Straaten H.M., Wester J.P., de Pont A.C., Schetz M.R. Anticoagulation strategies in continuous renal replacement therapy: can the choice be evidence based? // Intensive Care Med. 2006. Vol. 32. P. 188– 202.Oudemans-van Straaten H.M., Wester J.P., de Pont A.C., Schetz M.R. Anticoagulation strategies in continuous renal replacement therapy: can the choice be evidence based? // Intensive Care Med. 2006. Vol. 32. P. 188– 202.Perry S.L., O’Shea S.I., Byrne S. et al. A multi-dose pharmacokinetic study of dalteparin in haemodialysis patients // Thromb. Haemost. 2006. Vol. 96 (6). P. 750– 755.Perry S.L., O’Shea S.I., Byrne S. et al. A multi-dose pharmacokinetic study of dalteparin in haemodialysis patients // Thromb. Haemost. 2006. Vol. 96 (6). P. 750– 755.Schmid P., Broadmann D., Fischer A.G., Wuillemin W.A. Study of bioaccumulation of dalteparin at a prophylactic dose in patients with various degrees of impaired renal function // J. Thromb. Haemost. 2009. Vol. 7 (4). P. 552– 558.Schmid P., Broadmann D., Fischer A.G., Wuillemin W.A. Study of bioaccumulation of dalteparin at a prophylactic dose in patients with various degrees of impaired renal function // J. Thromb. Haemost. 2009. Vol. 7 (4). P. 552– 558.Stegmayr B., Olivecrona T., Olivecrona G. Lipoprotein lipase disturbances induced by uremia and hemodialy- sis // Semin Dial. 2009. Vol. 22 (4). P. 442–444.Stegmayr B., Olivecrona T., Olivecrona G. Lipoprotein lipase disturbances induced by uremia and hemodialy- sis // Semin Dial. 2009. Vol. 22 (4). P. 442–444.Uchino S., Bellomo R., Morimatsu H. et al. Continuous renal replacement therapy: a worldwide practice survey. The beginning and ending supportive therapy for the kidney (B.E.S.T. kidney) investigators // Intensive Care Med. 2007. Vol. 33 (9). P. 1563–1570.Uchino S., Bellomo R., Morimatsu H. et al. Continuous renal replacement therapy: a worldwide practice survey. The beginning and ending supportive therapy for the kidney (B.E.S.T. kidney) investigators // Intensive Care Med. 2007. Vol. 33 (9). P. 1563–1570.Uchino S., Fealy N., Baldwin I., Morimatsu H., Bello- mo R. Continuous venovenous hemofiltration without anticoagulation // ASAIO J. 2004. Vol. 50. P. 76–80.Uchino S., Fealy N., Baldwin I., Morimatsu H., Bello- mo R. Continuous venovenous hemofiltration without anticoagulation // ASAIO J. 2004. Vol. 50. P. 76–80.Vanholder R., Dhondt A. Recombinant hirudin: clinical pharmacology and potential applications in nephrolo- gy // BioDrugs. 1999. Vol. 11 (6). P. 417–429.Vanholder R., Dhondt A. Recombinant hirudin: clinical pharmacology and potential applications in nephrolo- gy // BioDrugs. 1999. Vol. 11 (6). P. 417–429.Vitale C., Verdecchia C., Bagnis C. et al. Effects of der- matan sulfate for anticoagulation in continuous renal replacement therapy // J. Nephrol. 2008. Vol. 21 (2). P. 205–212.Vitale C., Verdecchia C., Bagnis C. et al. Effects of der- matan sulfate for anticoagulation in continuous renal replacement therapy // J. Nephrol. 2008. Vol. 21 (2). P. 205–212.Wiemer J., Winkler K., Baumstark M. et al. Influence of low molecular weight heparin compared to conventional heparin for anticoagulation during haemodialysis on low density lipoprotein subclasses // Nephrol. Dial. Trans- plant. 2002. Vol. 17. P. 2231–2238.Wiemer J., Winkler K., Baumstark M. et al. Influence of low molecular weight heparin compared to conventional heparin for anticoagulation during haemodialysis on low density lipoprotein subclasses // Nephrol. Dial. Trans- plant. 2002. Vol. 17. P. 2231–2238.

The authors declare that there are no conflicts of interest present.