LDL-Apheresis in Two Patients with Extremely Elevated Lipoprotein (a) Levels

Bambauer, Rolf; Schiel, Ralf; Keller, H. E.; Latza, Reinhard

doi:10.1177/039139889501800507

Cited by 11 publications

(12 citation statements)

References 15 publications

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“…Having exhausted all other conservative treatment possibilities, LDL apheresis has been shown to be very effective in treatment of severe dyslipoproteinemia. The present reductions of serum lipid concen- trations under treatment with different methods of LDL apheresis are in agreement with the findings of other trials (20)(21)(22)(23)(24)(25)(26).…”

Section: Discussionsupporting

confidence: 91%

“…However, patients suffering from severe familial hyperlipoproteinemia, sometimes combined with elevated lipoprotein (a) (Lp[a]) levels, are often refractory to the above-mentioned therapies. With introduction of extracorporeal lipoprotein elimination (low density lipoprotein [LDL] apheresis), all forms of hyperlipidemia, which were therapy-resistant until then, are now effectively treatable (20)(21)(22)(23)(24)(25)(26). The apheresis methods used most frequently for regular treatment regimens are the following: cascade filtration, heparin-induced extracorporeal LDL precipitation (HELP), the dextran-sulfate method, and the immunoadsorption method.…”

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confidence: 99%

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LDL Apheresis in Clinical Practice: Long‐Term Treatment of Severe Hyperlipidemia

Bambauer

Schiel

Latza

et al. 1997

Therapeutic Apheresis

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Thirty patients (13 males, 17 females) suffering from familial hypercholesterolemia resistant to diet and lipid-lowering drugs were treated for 48.7 +/- 19.2 months (range, 2-87 months) with low density lipoprotein (LDL) apheresis. Three different systems (dextran sulfate adsorption for 27 of 30 [Kaneka, Liposorber, Japan], immunoadsorption system for 2 of 30 [Baxter, Therasorb, Germany], immunoadsorption system with special lipoprotein a [Lp(a)] columns for 1 of 30 patients [Lipopak, Pocard, Russia]) were applied. Before LDL apheresis 24 of 30 patients suffered from coronary heart disease (CHD) with angina symptoms. With LDL apheresis, reductions of 46% for total cholesterol, 49% for LDL, 30% for Lp(a), and 38% for triglycerides were reached. Severe side effects such as shock or allergic reactions were very rare (0.5%). In the course of treatment, an improvement in general well-being and increased performance were experienced in 27 of 30 patients. A 60 to 100% reduction of nitrate medication was observed in 17 of 24 patients. Regarding the different apheresis systems used, at the end of the trial there were no significant differences with respect to the clinical outcome experienced by the patients and concerning total cholesterol, LDL, high density lipoprotein, and triglyceride concentrations. But to reduce high Lp(a) levels, the immunoadsorption method with special Lp(a) columns seems to be the most effective (-57% versus 25% [Kaneka] and 23% [Baxter]). The present data clearly demonstrate that treatment with LDL apheresis of patients suffering from familial hypercholesterolemia, resistant to maximum conservative therapy, is very effective and safe, even in long-term application.

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Section: Discussionsupporting

confidence: 91%

mentioning

confidence: 99%

LDL Apheresis in Clinical Practice: Long‐Term Treatment of Severe Hyperlipidemia

Bambauer

Schiel

Latza

et al. 1997

Therapeutic Apheresis

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“…In some countries, cascade filtration is still in use. A recent development in this field is the introduction of several LDL apheresis techniques that are far more selective than the plasma exchange and cascade filtration procedures (28–34,49).…”

Section: Methods and Patientsmentioning

confidence: 99%

“…Patients suffering from severe FH, however, sometimes combined with elevated lipoprotein (a) (Lp[a]) levels, are often refractory to these therapies. With the introduction of LDL apheresis, all forms of hyperlipidemia that were therapy resistant are now effectively treatable (28–35).…”

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confidence: 99%

Low‐density Lipoprotein Apheresis: An Overview

Bambauer¹,

Schiel²,

Latza³

2003

Ther Apher Dial

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Atherosclerosis with myocardial infarction, stroke, and peripheral cellular disease still maintains its position at the top of morbidity and mortality statistics in industrialized nations. Established risk factors widely accepted are smoking, arterial hypertension, diabetes mellitus, and central obesity. Furthermore, there is a strong correlation between hyperlipidemia and atherosclerosis. The prognosis of patients suffering from severe hyperlipidemia, sometimes combined with elevated lipoprotein (a) (Lpa) levels, and coronary heart disease (CHD) refractory to diet and lipid-lowering drugs is poor. For such patients, regular treatment with low-density lipoprotein (LDL) apheresis is the therapeutic option. Today, there are four different LDL apheresis systems available: immunoadsorption, heparin-induced extracorporeal LDL/fibrinogen precipitation, dextran sulfate LDL adsorption and LDL hemoperfusion. Regarding the different LDL apheresis systems used, there is no significant difference with respect to the clinical outcome or concerning total cholesterol, LDL, high-density lipoprotein (HDL), or triglyceride concentrations. With respect to elevated Lpa levels, however, the immunoadsorption method seems to be the most effective. In 45 patients (25 women, 20 men) suffering from familial hypercholesterolemia resistant to diet and lipid lowering drugs, low-density lipoprotein (LDL) apheresis was performed over 95.6 +/- 44.7 months. Four different systems (Liposorber, 32 of 45, Kaneka, Osaka, Japan; Therasorb, 6 of 45, Baxter, Munich, Germany; Lipopak, 2 of 45, Pocard, Moscow, Russia; and Dali, 5 of 45, Fresenius, St. Wendel, Germany) were used. With all methods, average reductions of 57% for total cholesterol, 55.9% for LDL, 75.8% for lipoprotein a (Lpa), and 45.9% for triglycerides, and an average increase of 14.3% for HDL were reached. Severe side-effects such as shock or allergic reactions were very rare (0.3%) in all methods. In the course of treatment, an improvement in general well-being and increased performance were experienced by 44 of 45 patients. The present data demonstrate that treatment with LDL apheresis of patients suffering from familial hypercholesterolemia resistant to maximum conservative therapy is very effective and safe even in long-term application.

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“…With the elimination of other risk factors and exhausting all conservative therapy possibilities, LDL apheresis has developed from a treatment modality used in emergency situations into what today is the major indication for performing plasma therapy (1 1,12). It facilitates reduction of all cholesterols containing apolipoprotein B (apoB), such as total cholesterol, low-density lipoprotein (LDL), very low-density lipoprotein (VLDL), triglycerides, apoB and Lp(a), and fibrinogen, but not HDL (12)(13)(14)(15)(16)(17) With a variety of different systems, we planned this trial to evaluate the efficacy, clinical utility, and safety of LDL apheresis, particularly in long-term treatment. poproteinemia must focus on a reduction of elevated lipoprotein levels (5)(6)(7)(8).…”

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confidence: 99%

Treatment of Severe Hyperlipidemia: Six Years' Experience with Low–Density Lipoprotein Apheresis

et al. 1996

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In total, 30 patients suffering from familial hypercholesterolemia, resistant to diet and lipid-lowering drugs, were treated for up to 6 years (3.6 + or - 1.6; range, 0.2-6.8 years) with low-density lipoprotein (LDL) apheresis. Three different systems were used; the dextran sulfate adsorption system (Kaneka) for 27 of 30 patients, the immunoadsorption system from Baxter for 2 of 30 patients, and the immunoadsorption system with special lipoprotein(a) (Lp[a]) columns from Lipopak for one patient. Prior to the LDL apheresis, 23 of 30 patients suffered from coronary heart disease. Twenty of 23 patients suffered intermittently from symptoms of angina, excertional dyspnea, and claudication. With LDL apheresis, reductions of 47% for total cholesterol, 49% for LDL, 26% for Lp(a), and 40% for triglycerides were reached. Severe side effects such as shock or allergic reactions were very rare (0.55%). In the course of treatment with LDL apheresis, an improvement in general well-being and increased performance were experienced in 27 of 30 patients. A reduction of nitrate medication between 60 and 100% was observed in 17 of 23 patients. The present data clearly demonstrate that treatment with LDL apheresis in patients suffering from severe familial hyperlipidemia, resistant to maximum conservative therapy, is very effective and safe even over long periods of time.

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LDL-Apheresis in Two Patients with Extremely Elevated Lipoprotein (a) Levels

Cited by 11 publications

References 15 publications

LDL Apheresis in Clinical Practice: Long‐Term Treatment of Severe Hyperlipidemia

LDL Apheresis in Clinical Practice: Long‐Term Treatment of Severe Hyperlipidemia

Low‐density Lipoprotein Apheresis: An Overview

Treatment of Severe Hyperlipidemia: Six Years' Experience with Low–Density Lipoprotein Apheresis

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