Update 1988 pp 693-698 | Cite as

Anticoagulation for Extracorporeal System

  • M. E. Sinclair
Part of the Update in Intensive Care and Emergency Medicine book series (UICM, volume 5)


Blood, in the intact organism, is kept in a fluid state by the maintainance of an adequate blood flow, and rapid hepatic clearance of the coagulation factors following activation and fibrinolysis. There are also circulating serine protease inhibitors, such as antithrombin III (AT III), that prevent the spontaneous activation of certain factors in the coagulation cascade. During extracorporeal circulation, such as hemodialysis or cardiopulmonary bypass, the intrinsic pathway of the coagulation cascade is activated by the contact of the blood with a “foreign surface”. Once the cascade has been activated, it is necessary to use some form of anticoagulation to prevent clotting in the extracorporeal circuit.


Coagulation Cascade Contact Activation Extracorporeal Circulation Extracorporeal Circuit Systemic Anticoagulation 
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  1. 1.
    Nichols WL, Gerrard JM, Didisheim P (1981) Platelet structure, biochemistry and physiology. In: Poller L (ed) Recent Advances in Blood Coagulation 3-Churchill Livingstone, Edinburgh London Melbourne New York, pp 1-39.Google Scholar
  2. 2.
    Ansell J, Slepchuk N Jr, Kumar R, Lopez A, Southard L, Deykin D (1980) Heparin induced thrombocytopenia: a prospective study. Thromb Haemostas 43:61–65.Google Scholar
  3. 3.
    Rao AK, Holt JC, Pranee J, Niewiarowki S (1981) Release of platelet factor 4 in vivo after heparin injection. Thromb Haemostas 46:204 (Abstract).Google Scholar
  4. 4.
    Morabia A (1986) Heparin doses and major bleedings. Lancet 1:1278–1279.CrossRefPubMedGoogle Scholar
  5. 5.
    Gattinoni L, Pesenti A, Mascheroni D, et al (1986) Low frequency positive pressure ventilation with extracorporeal CO2 removal in acute respiratory failure. JAMA 25:881–886.CrossRefGoogle Scholar
  6. 6.
    Carter CJ, Kelton JG, Hirsch J, Gent M (1986) Relation between the anti thrombotic and the anticoagulant effects of low molecular weight heparin. Thromb Res 21:169–174.CrossRefGoogle Scholar
  7. 7.
    Carter CJ, Kelton JG, Hirsch J, Cerskus A, Santos AV, Gent M (1982) The relationship between the hemorrhagic and the antithrombotic properties of low molecular weight heparin in rabbits. Blood 59:1239–1245.PubMedGoogle Scholar
  8. 8.
    Massonet-Castel S, Pelissier E, Dreyfuss G, et al (1984) Low molecular weight heparin in extracorporeal circulation. Lancet 1:1182–1183.CrossRefGoogle Scholar
  9. 9.
    Harenberg J, Gnasso A, de Vries JX, Augustin J (1985) Inhibition of low molecular weight heparin by protamine chloride in vivo. Thromb Res 38:11–20.CrossRefPubMedGoogle Scholar
  10. 10.
    De Moerloose P, Schweizer A, Reber G, Sinclair M, Bouvier CA, Gardaz JP (1987) Comparison between a low molecular weight and standard heparin for anticoagulation during extracorporeal CO2 removal in the dog. Thromb Res (in press).Google Scholar
  11. 11.
    Editorial (1968) A new approach to anticoagulant therapy. Lancet 1:513.Google Scholar
  12. 12.
    Bell WR (1982) Defibrinogenating enzymes. In: Colman RW (ed) Hemostasis and Thrombosis. Lippincott, Philadelphia, pp 1013–1027.Google Scholar
  13. 13.
    Latello ZS (1983) Retrospective study on complications and adverse effects of treatment with thrombin-like enzymes. A multicentre trial. Thromb Haemostas 50:604–609.Google Scholar
  14. 14.
    Hall GH, Holman HM, Webster ADB (1970) Anticoagulation by ancrod for haemodialysis. BL Med J 4:591–593.CrossRefGoogle Scholar
  15. 15.
    Oedekoven B, Bey R, Mottaghy K, Schmid-Schonbein H (1984) Gabexate Mesilate (FOY) as an anticoagulant in extracorporeal circulation in dogs and sheep. Thromb Haemostas 52:329–332.Google Scholar
  16. 16.
    Richards NT, Mansell MA (1986) Developments in dialysis for renal failure. Br J Hosp Med 35:190–192.PubMedGoogle Scholar
  17. 17.
    Turney JH, Williams LC, Fewell MR, Parsons V, Weston MJ (1980) Platelet protection and heparin sparing with prostacyclin during regular dialysis therapy. Lancet 11:224–226.Google Scholar
  18. 18.
    Zusman RM, Rubin RH, Cato AE, Cocchetto DM, Crow JW, Tolkoff-Rubin N (1981) Haemodialysis using prostacyclin instead of heparin as the sole antithrombotic agent. N Engl J Med 304:934–939.CrossRefPubMedGoogle Scholar
  19. 19.
    Larm O, Larsson R, Olsson P (1983) A new non-thrombogenic surface prepared by selective covalent binding of heparin via a modified reducing terminal residue. Biomat Med Dev Art Org 11:161–173.Google Scholar
  20. 20.
    Inacio J, Bindslev L, Nilsson E, Gouda I, Olsson P (1986) Extracorporeal elimination of carbon dioxide using a surface heparinized vein-to-vein bypass system. Life Support Syst 4 Suppl 1:84–92.Google Scholar

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© Springer-Verlag Berlin Heidelberg 1988

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  • M. E. Sinclair

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