Prostacyclin

Prostacyclin (PGI2, epoprostenol), a potent antiplatelet agent with a short half-life, has been evaluated both as a substitute for, and as an adjunct to, standard heparin for HD of patients with acute or chronic renal insufficiency (Turney et al., 1980; Smith et al., 1982; Samuelsson et al., 1995). Adverse effects, such as nausea, vomiting, and hypotension, can be avoided by dose reduction, use of bicarbonate-instead of acetate-containing dialysate, or infusion of the drug at the inlet of the extracorporeal circuit. Because of its mode of action, prostacyclin cannot inhibit activation of coagulation during HD (Rylance et al., 1985; Novacek et al., 1997). Moreover, in a HIT patient receiving continuous venovenous HD, prostacyclin was unable to suppress platelet consumption effectively after heparin had been reinsti-tuted, owing to a false-negative platelet aggregation assay (Samuelsson et al., 1995). Prostacyclin thus does not seem to be a suitable antithrombotic agent for HD in HIT. Whether it may be a useful adjunct in selected cases remains to be clarified.

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