ADVERSE REACTIONS DURING EXTRACORPOREAL LIPID LOWERING THERAPY IN FAMILIAL HYPERLIPOPROTEINAEMIA

Objectives: LDL-apheresis is a method of extracorporeal LDL-lowering therapy, which is effective, however the procedures must be repeated relatively often and regularly for a long time. It is a rather time consuming and could be troubling for the patients.
Aim of the study: We summarized our results from the last 4 years (2000 – 2003) and refer about the tolerability and side effects of the method.
Methods: Blood cell separators Cobe-Spectra (software 5) were used as primary devices and adsorption–desorption automats ADA with the absorbers Lipopak 400® for the following LDL-cholesterol absorption. We analysed 463 procedures made in the interval of 17,5+6 days in 9 patients (2 homozygous, 7 heterozygous) with severe familial hyperlipoproteinaemia. The patients were followed during 3,6+0,5 years.
Results: The method was well tolerated and acceptable for the patients. The number of side-effects: 6,3% from 463 procedures. Mild symptoms of citrate toxicity (paresthesias) were relatively often, but  easy curable with calcium.  The most often were the symptoms of vasovagal lability (discomfort, weakness, nausea, short and mild hypotension - well controlled by symptomatic therapy in all cases) – 51,7% of all side-effects; some troubles connected with long stay in bed were observed in 10,3% of all side-effects. The procedure had to be finished  3 times for the bad peripheral vein status (the central venous catheter was not used).                                  

Conclusion: LDL-apheresis in this modification and in the hands of experienced staff is an effective, very tolerable and safe therapeutic method. The condition is a not interrupted and careful observation by the personal and than the side effects are relatively rare and not dangerous. An own system for prevention and recording of side effects was proposed.
Supported by the grant MH CZ NR/8505-3.