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The Scientific World Journal
Volume 2012 (2012), Article ID 314283, 19 pages
http://dx.doi.org/10.1100/2012/314283
Review Article

LDL-Apheresis: Technical and Clinical Aspects

1Institute for Blood Purification, Saar, 66424 Homburg, Germany
2Formerly Main Hospital Darmstadt, 64283 Darmstadt, Germany
3Laboratory of Medicine, 66386 St. Ingbert, Germany
4Inselklinik Heringsdorf GmbH, 17424 Seeheilbad Heringsdorf, Germany

Received 30 October 2011; Accepted 3 January 2012

Academic Editor: Kathleen M. Botham

Copyright © 2012 Rolf Bambauer et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

The prognosis of patients suffering from severe hyperlipidemia, sometimes combined with elevated lipoprotein (a) levels, and coronary heart disease 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 five different LDL-apheresis systems available: cascade filtration or lipid filtration, immunoadsorption, heparin-induced LDL precipitation, dextran sulfate LDL adsorption, and the LDL hemoperfusion. There is a strong correlation between hyperlipidemia and atherosclerosis. Besides the elimination of other risk factors, in severe hyperlipidemia therapeutic strategies should focus on a drastic reduction of serum lipoproteins. Despite maximum conventional therapy with a combination of different kinds of lipid-lowering drugs, sometimes the goal of therapy cannot be reached. Hence, in such patients, treatment with LDL-apheresis is indicated. Technical and clinical aspects of these five different LDL-apheresis methods are shown here. There were no significant differences with respect to or concerning all cholesterols, or triglycerides observed. With respect to elevated lipoprotein (a) levels, however, the immunoadsorption method seems to be most effective. The different published data clearly demonstrate that treatment with LDL-apheresis in patients suffering from severe hyperlipidemia refractory to maximum conservative therapy is effective and safe in long-term application.