THE CASE IS (B)(6) MALE PT ON MAINTENANCE HEMODIALYSIS. THE LDL-APHERESIS THERAPY WITH THE LIPOSORBER LA-15 SYSTEM (LDL-A) WAS COMMENCED FOR THE TREATMENT OF HIS ARTERIO SCLEROSIS OBLITERANS (ASO) ON AN OUTPATIENT BASIS ON (B)(6) 2015. THE PT WAS TREATED BY LDL-A FOR THE THIRD TIME ON (B)(6) 2015, AND THE TREATMENT FINISHED WITHOUT PROBLEM AND HE WENT HOME. THE NEXT DAY, HE DEVELOPED ARRHYTHMIA WITH TORSADES DE POINTES, AND ADMITTED TO THE ICU DIAGNOSED WITH WORSENING OF HEART FAILURE. CPK ELEVATION WAS OBSERVED FROM 105 IU / L (MEASUREMENT DATE UNK) TO 1449 IU / L . ALTHOUGH ACUTE MYOCARDIAL INFARCTION WAS SUSPECTED, NO SIGNIFICANT CORONARY STENOSIS WAS FOUND BY CORONARY ANGIOGRAPHY. THEN, HE FELT AT EASE AND WAS DISCHARGED FROM THE HOSP (DATE UNK).
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Patient 1
THE NEXT (4TH) LDL-A WAS CONDUCTED ON (B)(6) (15 DAYS AFTER THE REPORTED EVENT). ON THE SAME DAY, HE UNDERWENT HEMODIALYSIS AFTER THE LDL-A. IMMEDIATELY AFTER THE HEMODIALYSIS WAS OVER, CYANOSIS ON PERIPHERAL LIMBS, AND THE LIPS WERE DEVELOPED AND THEN THE SYMPTOMS WERE SUBSIDED. BLOOD PRESSURE WAS STABLE DURING THE LDL-A, AND ALSO IN THE HEMODIALYSIS. SINCE THEN, LDL-A THERAPY WAS SUSPENDED, AND ONLY HEMODIALYSIS HAS BEEN CONTINUED WITHOUT PROBLEM, AS OF (B)(6). PROBABLE CAUSE OF EVENT: ABOUT 400ML BLOOD CIRCULATION VOLUME MAY BE INCREASED BY THE BLOOD AND PLASMA RETURN AT THE END OF THE LDL-A PROCEDURE, ANDA POSSIBILITY THAT THE INCREASE IN HEART LOAD LED TO DEVELOPMENT OF ARRHYTHMIA AND WORSENING OF HEART FAILURE TRANSIENTLY CAN NOT BE DENIED. THE OTHER POSSIBLE CAUSE MAY BE THE SIDE EFFECTS OF CONCOMITANT MEDICATIONS; ALTHOUGH ALL DRUGS COULD NOT BE CONFIRMED, ONE OF THE POSSIBILITIES OF SUCH SIDE EFFECTS IS THAT OF NAFAMOSTAT MESYLATE USED AS AN ANTICOAGULANT ONLY DURING LDL-A. OUR COMMENT: ALL FOUR TIMES LDL-A TREATMENTS HAD BEEN COMPLETED WITHOUT ANY ABNORMALITIES, AND THE EVENT OCCURRED THE NEXT DAY OF THE 3RD LDL-A. SINCE THE PT HAD MEDICAL HISTORIES OF ARRYTHMIA, HEART FAILURE AND CARDIOVASCULAR DISEASE, WE BELIEVE THAT THE LDL-A PROCEDURE IS NOT RELEVANT TO THE EVENT, BUT IT'S CONTRIBUTION TO THE EVENT COULD NOT TOTALLY BE DENIED.