关键词: 连续性肾脏替代治疗, 萘莫司他, 阿加曲班, 凝血功能

Abstract: Objective To investigate the anticoagulation efficacy and safety of argatroban and nafamostat (NM) during continuous renal replacement therapy (CRRT) in the patients aged≥75 years old. Methods Twelve patients aged≥75 years old treated with argatroban and NM for 4 times respectively during CRRT were enrolled in this study. The monitoring data of the last 3 times of the two kinds of anticoagulant therapy were statistically analyzed. The levels of blood urea nitrogen (BUN), creatinine (Cr), hemoglobin (Hb), platelet count (PLT) and activated partial thromboplastin time (APTT) were detected before and after CRRT, and the level of APTT at venous and arterial ends 4 h and 8 h after treatment were also detected. The incidence rates of clotting events in filter tubes and bleeding during CRRT were recorded. Results There were no significant differences in the D-value of BUN, Cr and PLT between the two groups before and after CRRT (all P>0.05). There was no significant difference in the classification of dialyzer and tube coagulation between the two groups (P=0.40). The incidence rate of fecal occult blood in NM group was significantly lower than that in argatroban group (P=0.03), and there were no significant differences in the incidence rates of blood in sputum or hematuria between the two groups (P>0.05). After treatment, the level of Hb in argatroban group was significantly decreased compared to NM group (P<0.01), and the level of APTT in peripheral blood in argatroban group was significantly increased compared to NM group (P<0.01). Affter 4 h and 8 h of treatment, there were no significant differences in the level of APTT at venous end between the two groups (P>0.05), but the level of APTT at arterial end in NM group was significantly lower than that in argatroban group (P<0.01). Conclusions NM has considerable anticoagulant effect comparable to argatroban, with no significant effect on coagulation function during and after CRRT, and has less effect on Hb. It is a better choice for anticoagulants during CRRT in the patients aged≥75 years old.

Key words: continuous renal replacement therapy, nafamostat, argatroban, coagulation function