萘莫司他与阿加曲班在≥75岁病人连续性肾脏替代治疗期间的抗凝效果对比

doi:10.3969/j.issn.1003-9198.2023.12.009

Abstract

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

CLC Number:

R 629.5

WANG Ting, LI Min, ZENG Ping, CHAI Chun-yan, ZHAO Yuan, LI Yan-ling. Comparison of anticoagulation effects between nafamostat and argatroban during continuous renal replacement therapy in elderly patients aged≥75 years old[J]. Practical Geriatrics, 2023, 37(12): 1224-1227.

References

[1] VAN DE WETERUNG J, WESTENDORP R G, VAN DER HOEVEN J G, et al. Heparin use in continuous renal replacement procedures: the struggle between filter coagulation and patient hemorrhage[J]. J Am Soc Nephrol, 1996, 7(1):145-150.
[2] LANG Y, ZHENG Y, QI B, et al. Anticoagulation with nafamostat mesilate during extracorporeal life support[J]. Int J Cardiol, 2022, 366:71-79.
[3] BAEK N N, JANG H R, HUH W, et al. The role of nafamostat mesylate in continuous renal replacement therapy among patients at high risk of bleeding[J]. Ren Fail, 2012, 34(3):279-285.
[4] MAKINO S, EGI M, KITA H, et al. Comparison of nafamostat mesilate and unfractionated heparin as anticoagulants during continuous renal replacement therapy[J]. Int J Artif Organs, 2016, 39(1):16-21.
[5] OHTAKE Y, HIRASAWA H, SUGAI T, et al. Nafamostat mesylate as anticoagulant in continuous hemofiltration and continuous hemodiafiltration[J]. Contrib Nephrol, 1991, 93:215-217.
[6] 许元文, 黄娜娅, 李水, 等. 应重视枸橼酸抗凝在血液净化中的应用[J]. 中华医学杂志, 2023, 103(8):541-544.
[7] YU J, BRISBOIS E, HANDA H, et al. The immobilization of a direct thrombin inhibitor to a polyurethane as a nonthrombogenic surface coating for extracorporeal circulation[J]. J Mater Chem B, 2016, 4(13):2264-2272.
[8] VAN COTT E M, ROBERTS A J, DAGER W E. Laboratory monitoring of parenteral direct thrombin inhibitors[J]. Semin Thromb Hemost, 2017, 43(3):270-276.
[9] LEE J H, PARK J H, JANG J H, et al. The role of nafamostat mesilate as a regional anticoagulant during extracorporeal membrane oxygenation[J]. Acute Crit Care, 2022, 37(2):177-184.
[10] ZHANG W, BAI M, YU Y, et al. Continuous renal replacement therapy without anticoagulation in critically ill patients at high risk of bleeding: a systematic review and meta-analysis[J]. Semin Dial, 2021, 34(3):196-208.
[11] MARUYAMA H, MIYAKAWA Y, GEJYO F, et al. Anaphylactoid reaction induced by nafamostat mesilate in a hemodialysis patient[J]. Nephron, 1996, 74(2):468-469.
[12] SHIOYA N, INOUE N, SATO H, et al. Cardiopulmonary arrest caused by nafamostat mesylate during hemodialysis[J]. Clin Case Rep, 2022, 10(7):e6140.

Comparison of anticoagulation effects between nafamostat and argatroban during continuous renal replacement therapy in elderly patients aged≥75 years old

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