Low density lipoprotein apheresis is used in the treatment of severe familial hypercholesterolemia and advanced coronary heart disease.
Temporary hypotension: 1%.
Concomitant use of ACE inhibitors.
General: hypotension, bradycardia.
Cutaneous: flushing, facial edema.
Digestive: nausea, abdominal pain.
Because of its strong negative charges, dextran sulphate is a potent activator of the contact activation system (Hageman factor, high molecular weight kininogen, prekallikrein, coagulation factor XI).
Kallikrein generates bradykinin from high molecular weight kininogen. LDL apheresis with dextran sulphate is associated with increased bradykinin generation. Bradykinin catabolism is decreased by ACE inhibitors. Bradykinin is a potent vasodilator and smooth muscle constrictor in bronchi and intestine.
Withdraw captopril 24 hours before treatment.
No reaction is observed when futhan is used instead of heparin (protease inhibitory activity of futhan).