Concurrent Hemoperfusion and Hemodialysis in Patients with Acute Pesticide Intoxication

Park, Samel; Lee, Sunhyo; Park, Suyeon; Gil, Hyo‐Wook; Lee, Eun-Young; Yang, Jong‐Oh; Hong, Sae‐Yong

doi:10.1159/000451051

Cited by 10 publications

(11 citation statements)

References 21 publications

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“… 19 Park and colleagues investigated the efficacy of HP–HD consecutive therapy (n=347) and concurrent therapy (n=383) and found that HP–HD concurrent therapy had a lower mortality (57.9% vs 81.8%). 28 In a Chinese study by Liu et al , the mortality of conservative therapy for PQ poisoned patients was 78.2% (n=87). 29 Even less evidence could be obtained in HD treatment for PQ poisoning in the last 30 years.…”

Section: Methods and Analysismentioning

confidence: 99%

Efficacy of initial haemopurification strategy for acute paraquat poisoning in adults: study protocol for a randomised controlled trial (HeSAPP)

Cui

Wang

et al. 2018

BMJ Open

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IntroductionParaquat (PQ) is a widely used herbicide which is inexpensive and easily accessible for people in rural areas. A small amount of PQ ingestion could be lethal, yet currently, the optimal treatment is still controversial. Extracorporeal therapies (ECTR) have been practised in PQ poisoning management, though limited evidence could be obtained to suggest its superiority over conservative therapy. Haemodialysis (HD) and haemoperfusion (HP) are most commonly used, while some institutions also choose HP–HD concurrent therapy. The object of the present trial is to investigate whether haemopurification therapy can reduce mortality compared with conservative therapy.Methods and analysisThis is a planned single-centre, non-blinded, randomised controlled trial. Acute PQ poisoned adults who have orally ingested PQ within 24 hours would be recruited. A total of 360 patients would be recruited and randomly assigned to four groups, that is, HP, HD, concurrent HP–HD and control, at a 1:1:1:1 ratio. Subjects would be also stratified by their urine dithionite test results. Primary outcome is 28-day all-cause mortality. Secondary outcomes include survival time, all-cause mortality at the 3rd, 7th and 60th day, rate of major complications, Acute Physiologic and Chronic Health Evaluation score and Poisoning Severity Score, etc.Ethics and disseminationThe protocol and informed consent documents have been approved by the Ethics Committee of The First Affiliated Hospital of Zhengzhou University in September 2017 (approval number: 2017-KY-10). The result of this trial would be submitted to peer-reviewed journal.Trial registration numberNCT03314909; Pre-results.

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Section: Methods and Analysismentioning

confidence: 99%

Efficacy of initial haemopurification strategy for acute paraquat poisoning in adults: study protocol for a randomised controlled trial (HeSAPP)

Cui

Wang

et al. 2018

BMJ Open

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“…HP was performed as previously reported 6 . Briefly, an Adsorba 300 C HP cartridge (Baxter, KG Hechingen, Germany), which has modified charcoal adsorbent coated with cellulose, with a 300 m 2 surface area was used.…”

Section: Methodsmentioning

confidence: 99%

“…Our institution previously reported that systemic bleeding was observed in 3% of patients with acute intoxication who underwent HP, and that it was an important factor associated with mortality 1 . The average platelet counts has also been reported to decrease about by 30% per HP session 6 .…”

Section: Introductionmentioning

confidence: 94%

Hemoperfusion leads to impairment in hemostasis and coagulation process in patients with acute pesticide intoxication

Park

Islam

Jeong

et al. 2019

Sci Rep

Self Cite

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Hemoperfusion (HP) is one of the important treatment modalities in extracorporeal therapy for patients with acute intoxication. Its use has declined during the past 20 years despite its efficacy, because of its side effects, especially an increased risk of bleeding. Mechanisms of hemostasis impairment have not been clearly elucidated and studies demonstrating the mechanism are lacking. It is not clear which step of the hemostatic process is impaired during HP, and whether it leads to an increased risk of bleeding. We performed both in vivo and in vitro studies to elucidate the mechanism of impairment in the hemostatic process. In patients with acute pesticide intoxication who underwent HP, the platelet count decreased rapidly during the first 30 minutes from 242.4 ± 57.7 × 103/μL to 184.8 ± 49.6 × 103/μL, then gradually decreased even lower to 145.4 ± 61.2 × 103/μL over time (p < 0.001). As markers of platelet activation, platelet distribution width increased continuously during HP from 41.98 ± 9.28% to 47.69 ± 11.18% (p < 0.05), however, mean platelet volume did not show significant change. In scanning electron microscopy, activated platelets adhered to modified charcoal were observed, and delayed closure time after HP in PFA-100 test suggested platelet dysfunction occurred during HP. To confirm these conflicting results, changes of glycoprotein expression on the platelet surface were evaluated when platelets were exposed to modified charcoal in vitro. Platelet expression of CD61, fibrinogen receptor, significantly decreased from 95.2 ± 0.9% to 73.9 ± 1.6%, while those expressing CD42b, von Willebrand factor receptor, did not show significant change. However, platelet expression of CD49b, collagen receptor, significantly increased from 24.6 ± 0.7% to 51.9 ± 2.3%. Thrombin-antithrombin complex, a marker for thrombin generation, appeared to decrease, however, it was not statistically significant. Fibrin degradation products and d-dimers, markers for fibrinolysis, increased significantly during HP. Taken together, our data suggests that hemoperfusion leads to impairment of platelet aggregation with incomplete platelet activation, which was associated with reduced thrombin generation, accompanied by increased fibrinolysis.

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“…[1] Artificial DOI: 10.1002/adhm.202200270 detoxification methods, such as blood dialysis, gastric lavage, and the administration of active charcoal and antidotes, have been broadly applied in clinical practice. [2][3][4][5] According to the detoxifying mechanisms, antidote-based detoxification mainly occurs via two approaches: pharmacodynamic or pharmacokinetic approaches. The pharmacodynamic approach targets the body by modulation or disrupting the action of biotoxin on its sites of action.…”

Section: Introductionmentioning

confidence: 99%

Supramolecular Detoxification of Macromolecular Biotoxin through the Complexation by a Large‐Sized Macrocycle

Zhao

Chen

Li³

et al. 2022

Adv Healthcare Materials

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Biotoxins are diverse, complex, and hypertoxic, ultimately serving as grave and lasting menaces to humanity. Here, it is aimed to introduce a new detoxification methodology for macromolecular biotoxin through complexation by a very large macrocycle. A 25‐mer peptide isolated from Lycosa erythrognatha spider venom (LyeTxI) is selected as the model macromolecular biotoxin. Quaterphen[4]arene, with a side length of ≈1.6 nm, has a sufficient cavity to bind LyeTxI. Hence, the water‐soluble derivative of Quaterphen[4]arene (H) is designed and synthesized. H exhibits an overall host–guest complexation toward LyeTxI, resulting in a considerably high association constant of (7.01 ± 0.18) × 107 m−1. This encapsulation of peptide is interesting as traditional macrocycles can only engulf the amino acid residues of peptides due to their limited cavity size. In vitro assay verifies that complexation by H inhibits the interactions of LyeTxI with cell membranes, thereby reducing its cytotoxicity, suppressing hemolysis, and decreasing the release of lactate dehydrogenase. Notably, the intravenous administration of H has a significant therapeutic effect on LyeTxI‐poisoned mice, alleviating inflammation and tissue damage, and markedly improving the survival rate from 10% to 80%. An efficient and potentially versatile approach is provided to detoxify macromolecular biotoxins, with giant macrocycle serving as an antidote.

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Concurrent Hemoperfusion and Hemodialysis in Patients with Acute Pesticide Intoxication

Cited by 10 publications

References 21 publications

Efficacy of initial haemopurification strategy for acute paraquat poisoning in adults: study protocol for a randomised controlled trial (HeSAPP)

Efficacy of initial haemopurification strategy for acute paraquat poisoning in adults: study protocol for a randomised controlled trial (HeSAPP)

Hemoperfusion leads to impairment in hemostasis and coagulation process in patients with acute pesticide intoxication

Supramolecular Detoxification of Macromolecular Biotoxin through the Complexation by a Large‐Sized Macrocycle

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