Presented in part at the 29th Annual Meeting of the Japanese Society for Apheresis held November 21–23, 2008, in Hiroshima, Japan.
Hemoperfusion With a Polymyxin B Fiber Column Decreases Clotting Activity
Article first published online: 26 NOV 2009
© 2009 The Authors. Journal compilation © 2009 International Society for Apheresis
Therapeutic Apheresis and Dialysis
Volume 13, Issue 6, pages 528–533, December 2009
How to Cite
Kushi, H., Miki, T., Sakagami, Y., Sato, J., Saito, T. and Tanjoh, K. (2009), Hemoperfusion With a Polymyxin B Fiber Column Decreases Clotting Activity. Therapeutic Apheresis and Dialysis, 13: 528–533. doi: 10.1111/j.1744-9987.2009.00776.x
- Issue published online: 26 NOV 2009
- Article first published online: 26 NOV 2009
- Received February 2009.
- Direct hemoperfusion;
- Plasmin-α2 plasmin inhibitor complex;
- Polymyxin B column;
- Thrombin antithrombin complex
We investigated whether hemoperfusion with a polymyxin B column (DHP-PMX) was able to improve coagulation abnormalities in patients with sepsis. Sixteen patients with sepsis were enrolled in the study. They all had signs of systemic inflammatory response syndrome due to infection and a mean arterial blood pressure ≥65mm Hg (irrespective of the use of catecholamines). A thermodilution catheter was inserted prior to DHP-PMX for intravenous infusion, and DHP-PMX was performed twice within 24 h for 3 h each time. Circulating levels of thrombin–antithrombin complex (TAT), plasmin-α2 plasmin inhibitor complex (PIC), the TAT/PIC ratio, and plasminogen activator inhibitor-1 (PAI-1) were measured six times. Before DHP-PMX, the TAT level was 24.5 ± 8.3 ng/mL, the PIC level was 2.5 ± 1.1 µg/mL, the TAT/PIC ratio was 13.9 ± 3.5, and the PAI-1 level was 143.0 ± 24.4 ng/L. The TAT level, TAT/PIC ratio, and PAI-1 were all significantly lower (P < 0.05) after 48 hr compared with before DHP-PMX, but no significant change of PIC was observed. In these patients with sepsis, fibrinolysis was inhibited by PAI-1, whereas clotting activity was significantly increased. This coagulation/fibrinolysis imbalance was improved by DHP-PMX. The present results suggest that indirect inhibition of clotting activity can be achieved in patients with sepsis through adsorption of lipopolysaccharide by DHP-PMX.