Different effects of two methods of low‐density lipoprotein apheresis on the coagulation and fibrinolytic systems<sup>3</sup>

Knisel, Werner; Nicuolo, A. Di; Pfohl, Martin; Müller, H; Risler, T.; Eggstein, M.; Seifried, Erhard

doi:10.1111/j.1365-2796.1993.tb00781.x

Cited by 52 publications

(30 citation statements)

References 20 publications

(7 reference statements)

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“…The hs-CRP reduction by both DSA and DALI was also significant, with DSA being the more effective, but lower than reported for HELP apheresis [18]. The reduction in fibrinogen concentration was also significant by both apheretic methods, in accordance with previous reports [19], but lower than those reported with the HELP apheresis. Whether CRP is a biomediator of atherogenesis or only a biomarker of another inflammatory process remains to be elucidated.…”

Section: Discussionsupporting

confidence: 87%

Effect of different LDL‐apheresis methods on parameters involved in atherosclerosis

Hershcovici

Schechner

Orlin

et al. 2004

J of Clinical Apheresis

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LDL-apheresis lowers the LDL level in patients with severe hypercholesterolemia. The present study compared three apheresis methods--DSA, DALI, and plasma exchange--for effectiveness in removal of LDL and effect on various blood parameters involved in atherogenesis. The study group included 6 patients with primary hypercholesterolemia unresponsive to maximal drug therapy. All were treated first with 4 consecutive plasma exchange sessions followed by 4 DSA sessions; in four out of six, an additional 4 sessions of DALI were then performed. Levels of lipoproteins, apoproteins, CRP, homocysteine, fibrinogen, and blood count were determined before and after each session. All 3 procedures yielded a significant reduction in total cholesterol and ApoB-containing lipoproteins, with DALI being the most effective. Also, a significant reduction in triglycerides, HDL, and ApoA1 was observed with all the methods. The reduction in HDL-C with DSA and DALI was greater than previously reported. The LDL/HDL-cholesterol ratio decreased significantly with DSA and DALI and increased with plasma exchange. There was a significant decrease in CRP, fibrinogen, and platelets with all three methods, and a significant decrease in homocysteine only with DSA and DALI. All three procedures effectively reduced the concentration of various compounds involved in atherosclerosis. Plasma exchange is nonselective and cannot be recommended as the procedure of choice.

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Section: Discussionsupporting

confidence: 87%

Effect of different LDL‐apheresis methods on parameters involved in atherosclerosis

Hershcovici

Schechner

Orlin

et al. 2004

J of Clinical Apheresis

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“…A drastic reduction in LDL cholesterol reduces blood viscosity [35] and improves erythrocytic deformability [36] . Moreover, the removal of clotting factors, namely factor VIII and von Willebrand factor, helps improve the hemorheological picture [5,6,37] . Thus, the endothelial dysfunction, featuring a reduced production of nitric oxide, can be corrected by a single session of LDL apheresis [38] , bringing about vasodilation of the coronary circulation [39,40] .…”

Section: Discussionmentioning

confidence: 99%

Is the Efficacy of LDL Apheresis in Ischemic Optic Neuropathy Linked to a Reduction in Endothelial Activation Markers?

Ramunni¹,

Ranieri²,

Giancipoli³

et al. 2006

Blood Purif

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Endothelial dysfunction of the optic microcirculation is considered to be the main pathogenetic mechanism in nonarteritic ischemic optic neuropathy. The aim of the present work was to assess whether a clinical improvement is correlated with a reduction in the endothelial activation markers by means of LDL apheresis (LDLA). Three weekly sessions of LDLA were administered in 23 patients affected by nonarteritic ischemic optic neuropathy. Statistically significant reductions were achieved in all parameters: total cholesterol (44.6%), LDL cholesterol (54.6%), fibrinogen (60.9%), von Willebrand factor (38.6%), sE-Selectin (22.6%), sICAM-1 (14%) and sVCAM-1 (15.5%), each of which was correlated with an improvement in the mean deviation of the visual field, although statistical significance for the single parameters was not reached. However, analysis of variance between the mean deviation improvement and the set of parameters taken together yielded highly significant results (p < 0.0001). LDLA was effective in reducing the values of all evaluated endothelial activation markers, and this trend was correlated with an improvement in the visual field.

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“…The efficacy of LDL apheresis for patients with PAOD has been suggested by several lines of evidence [8,9,10,11,12,13,14,15,16,17,18,19]. Clinical evidence has suggested the following as mechanisms of the improvement of clinical symptoms in PAOD patients.…”

Section: Discussionmentioning

confidence: 99%

“…Acute and drastic lowering of serum lipid levels could improve blood rheology by reducing blood viscosity [9] or improving red-cell deformability [10]. In addition, significant reductions of plasma fibrinogen and coagulation factors such as von Willebrand factor [11, 12] could improve peripheral circulation. Generation of bradykinin [13] or nitric oxide [14, 15], elevated production of PGI 2 by vascular cells [16], reduction of adhesion molecule expression on mononuclear cells [17], and improvement of endothelium-dependent vasodilation can occur with a single session of LDL apheresis [14].…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Low-Density Lipoprotein Apheresis in Patients with Peripheral Arterial Occlusive Disease Undergoing Hemodialysis Treatment

et al. 2007

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Background: Low-density lipoprotein (LDL) apheresis is effective in the treatment of peripheral arterial occlusive disease (PAOD). In the present study, we attempted to determine whether LDL apheresis is effective even for PAOD patients undergoing hemodialysis, who tend to be refractory to any treatment, and if so, to determine the mechanism of its efficacy. Methods: Serum levels of lipids and vascular growth factors, leg symptom, and endothelium-dependent vasodilation were investigated before and after 10 sessions of LDL apheresis in 11 PAOD patients undergoing hemodialysis. Results: Serum levels of total cholesterol, LDL cholesterol, and triglyceride exhibited drastic reduction, which completely disappeared 4 weeks after the final apheresis. Resting leg pain was improved in 6 cases even 4 weeks after final apheresis. Endothelium-dependent vasodilation was significantly increased 4 weeks after final apheresis (1.6 ± 0.6 to 4.7 ± 1.0%, p < 0.05). Levels of vascular growth factors, hepatocyte growth factor and vascular endothelial growth factor were not changed during treatment. Conclusions: These findings suggested that LDL apheresis is effective even in PAOD patients undergoing hemodialysis. Our findings suggest that its mechanisms of efficacy include improvement of vascular endothelial dysfunction, in addition to drastic but acute reduction of lipid levels. Since PAOD patients undergoing hemodialysis tend to be resistant to any treatment and are at high risk for lower-extremity amputation, LDL apheresis could be a useful strategy for treatment of them.

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Different effects of two methods of low‐density lipoprotein apheresis on the coagulation and fibrinolytic systems³

Abstract: DSA exerts a more profound effect on the coagulation system than IMA by a substantial co-elimination of various clotting factors in addition to the desired removal of atherogenic lipoproteins.

Cited by 52 publications

References 20 publications

Effect of different LDL‐apheresis methods on parameters involved in atherosclerosis

Effect of different LDL‐apheresis methods on parameters involved in atherosclerosis

Is the Efficacy of LDL Apheresis in Ischemic Optic Neuropathy Linked to a Reduction in Endothelial Activation Markers?

Efficacy of Low-Density Lipoprotein Apheresis in Patients with Peripheral Arterial Occlusive Disease Undergoing Hemodialysis Treatment

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Different effects of two methods of low‐density lipoprotein apheresis on the coagulation and fibrinolytic systems3

Abstract: DSA exerts a more profound effect on the coagulation system than IMA by a substantial co-elimination of various clotting factors in addition to the desired removal of atherogenic lipoproteins.

Cited by 52 publications

References 20 publications

Effect of different LDL‐apheresis methods on parameters involved in atherosclerosis

Effect of different LDL‐apheresis methods on parameters involved in atherosclerosis

Is the Efficacy of LDL Apheresis in Ischemic Optic Neuropathy Linked to a Reduction in Endothelial Activation Markers?

Efficacy of Low-Density Lipoprotein Apheresis in Patients with Peripheral Arterial Occlusive Disease Undergoing Hemodialysis Treatment

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Different effects of two methods of low‐density lipoprotein apheresis on the coagulation and fibrinolytic systems³