Why an apheresis center should offer more than one lipoprotein apheresis method.

We describe our experience with the performance of six lipoprotein apheresis methods (HELP, TheraSorb LDL, DALI, lipidfiltration, Liposorber D, MONET) which have been used in 68 patients. Thirty-four of them have been treated with more than one method. The calculations presented in this paper are based on laboratory data measured at the last three available apheresis sessions before the switch to another method and at the end of the observation period, respectively. With respect to the reduction of low-density lipoprotein (LDL) cholesterol, DALI and Liposorber D appeared to be the most effective lipoprotein apheresis methods, for reduction of lipoprotein(a), Liposorber D. Data on the influence of these lipoprotein apheresis methods on parameters of the coagulation system (prothrombin time, international normalized ratio, activated partial thromboplastin time, fibrinogen) are also reported. The histories of three patients who have been switched to several lipoprotein apheresis methods are given as examples. The major reason for switching was the low efficiency of a given lipoprotein apheresis method with respect to lowering of LDL cholesterol; the reason for this phenomenon was not clear in each case. In three patients who took an oral anticoagulant and were treated with HELP, the influence on the coagulation system is reported; they were submitted to another apheresis method. In two patients we observed an allergy to heparin-they were then treated with a heparin-free apheresis method. In conclusion, we point out that there are several reasons why an apheresis center should offer more than one lipoprotein apheresis method.