连续性血液净化中阿加曲班与枸橼酸钠的抗凝效果及安全性比较

Abstract
Figure/Table
References
Related Citation (6)

Download: PDF (692 KB) HTML (1 KB)
Export: BibTeX | EndNote (RIS)

Abstract Objective To compare the anticoagulant effect and safety of argatroban and sodium citrate in continuous renal replacement therapy (CRRT). Methods A total of 132 patients treated between September 2018 and May 2019 were randomly divided into the argatroban group (n=60) and sodium citrate group (n=72). The two groups were treated with argatroban and sodium citrate as the anticoagulant therapy respectively. The general condition, activated clotting time (ACT),serum calcium, hemoglobin (Hb),platelet count (PLT) and urea reduction rate (URR) were recorded and compared between the two groups. The blood coagulation of filters and pipes during treatment and bleeding events 24 h after treatment were also observed and compared. Results There was no significant difference in general data between the two groups.The ACT was within the normal range before treatment in both groups. In the argatroban group,the ACT was significantly increased 5 min, 2 h and 4 h into the treatment (P<0.05), but significantly reduced to the normal range after 1 hour of treatment. In the sodium citrate group, there was no significant change in the ACT during or after treatment. There was also no significant change in levels of serum calcium before, during and after dialysis in the sodium citrate group.The levels of serum calcium in vitro during dialysis were lower than those in vivo at the same time (P<0.05). There was no significant change in Hb or PLT before and after treatment, and the serum creatinine level was significantly decreased in the two groups (P<0.05). There was no statistically significant difference in the duration of treatment, URR value, coagulation in the pipeline filters and bleeding events between the two groups. Conclusions Argatroban and sodium citrate are effective and safe anticoagulants in the treatment of CRRT. For patients at high risk of bleeding, sodium citrate may be a better choice.

Key words： argatroban sodium citrate anticoagulant therapy continuous blood purification renal replacement therapy

Received: 10 September 2019

ZTFLH:

R589.9

	Service

	E-mail this article
	Add to my bookshelf
	Add to citation manager
	E-mail Alert
	RSS
	Articles by authors
	ZHANG Xin
	ZHANG Wenbo
	LI Ying
	LI Hao
	LIU Yuanyuan
	HUO Yanhong

Cite this article:

ZHANG Xin,ZHANG Wenbo,LI Ying等. Comparison of efficacy and safety of argatroban and sodium citrate in continuous blood purification therapy[J]. Med. J. Chin. Peop. Armed Poli. Forc., 2020, 31(2): 103-106.

URL:

http://journal08.magtechjournal.com/Jwk_wjyx/EN/ OR http://journal08.magtechjournal.com/Jwk_wjyx/EN/Y2020/V31/I2/103

[1]	Swan S K, Hursting M J. The pharmacokinetics and pharmacodynamics of argatroban: effects of age, gender, and hepatic or renal dysfunction[J]. Pharmacotherapy, 2012, 20(3):318-329.
[2]	Nurmohamed S A, Jallah B P, Vervloet M G, et al. Continuous venovenous haemofiltration with citrate-buffered replacement solution is safe and efficacious in patients with a bleeding tendency: a prospective observational study[J]. Bmc Nephrology, 2013, 14(1):89-89.
[3]	杨旭, 田密, 李德天. 阿加曲班在血液净化治疗中的应用[J]. 实用药物与临床, 2014(6):684-687.
[4]	王大伟, 尹贻梅, 姚咏明. 危重病相关的血小板减少及功能障碍[J]. 中华急诊医学杂志, 2013, 22(11):1304-1307.
[5]	Rice L, Hursting M J, Baillie G M, et al. Argatroban anticoagulation in obese versus nonobese patients: implications for treating heparin-induced thrombocytopenia[J]. Br J Clin Pharmacol, 2013, 47(8):1028-1034.
[6]	陈香美.血液净化标准操作规程[M].3版.北京:北京科学技术出版社,2011:446-447.
[7]	Stevens P E,Andrassy K M.KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease[J]. Kidney International, 2013, 158(1):825-830.
[8]	Kondo L M, Wittkowsky A K, Wiggins B S. Argatroban for prevention and treatment of thromboembolism in heparin-induced thrombocytopenia[J]. Ann Pharmacother, 2001, 35(4):440-451.
[9]	Nurmohamed S A, Jallah B P, Vervloet M G, et al. Continuous venovenous haemofiltration with citrate-buffered replacement solution is safe and efficacious in patients with a bleeding tendency: a prospective observational study[J]. Bmc Nephrology, 2013, 14(1):89-89.
[10]	Stevens P E, Levin A. Evaluation and management of chronic kidney disease: synopsis of the kidney disease: improving global outcomes 2012 clinical practice guideline[J]. Ann Internal Med, 2013, 158(11):825.
[11]	Kramer L, Bauer E, Joukhadar C, et al. Citrate pharmacokinetics and metabolism in cirrhotic and noncirrhotic critically ill patients[J]. Critical Care Med, 2003, 31(10):2450-2455.
[12]	Cubattoli L, Teruzzi M, Cormio M, et al. Citrate anticoagulation during CVVH in high risk bleeding patients[J]. Int J Artif Organs, 2007, 30(3):244-252.
[13]	Tabla. Heparin-induced thrombocytopenia in haemodialysis treated with argatroban[J]. Nefrologia, 2014, 34(5):670.
[14]	Balogun R A, Turgut F, Caldwell S, et al. Regional citrate anticoagulation in critically ill patients with liver and kidney failure[J]. Am J Nephrol, 2012, 25(1):113.
[15]	Grouzi E. Update on argatroban for the prophylaxis and treatment of heparin-induced thrombocytopenia type Ⅱ[J]. J Blood Med, 2014, 2014(1):131.