小剂量阿加曲班在连续性肾脏替代治疗中的疗效和安全性分析

Anticoagulative efficacy and safety of small dose argatroban in continuous renal replacement therapy

目的:探讨小剂量阿加曲班在高出血风险患者行连续性肾脏替代治疗(CRRT)中的抗凝效果以及安全性。方法:入选高出血风险患者给予阿加曲班0.1~0.3μg·(kg·min)^(-1)抗凝,评估凝血指标、滤器管路凝血事件、全身出血事件以及血象和肝功能指标。结果:共入选28例高出血风险患者行CRRT397周期,与CRRT前相比:治疗期间和CRRT结束后0~3h的活化部分凝血活酶时间(APTT)差异有显著性(P=0.000);CRRT结束3h后APTT的差异无显著性。根据CRRT上机2~4h的APTT以及血液净化管路动静脉压情况调整阿加曲班给药剂量共114次,调整剂量后复测APTT较前降低,与CRRT上机2~4h相比,差异有显著性(P=0.034)。CRRT期间发生管路和滤器凝血事件共55周期(13.85%)。阿加曲班抗凝期间发生出血事件6例,其中气道出血3例,皮肤瘀斑2例,消化道出血1例,CRRT期间继续减量使用阿加曲班抗凝未观察到有出血加重事件。结论:APTT与阿加曲班抗凝剂量具有较好的相关性,在CRRT结束后凝血指标较快恢复正常,小剂量阿加曲班对高出血风险患者CRRT期间抗凝治疗具有较好的抗凝效果和安全性。

OBJECTIVE To investigate the anticoagulative efficacy and safety of argatroban in patients with high risk of bleeding receiving continuous renal replacement therapy（CRRT）.METHODS Patients with high risk of bleeding received argatroban 0.1-0.3μg·（kg·min）^（-1） during CRRT therapy.Coagulation parameters,clotting events,systemic bleeding events were evaluated for the anticoagulative efficacy and safety of argatroban.RESULTS Twenty eight cases with high risk of bleeding received CRRT totally for 397 cycles.Compared to that before CRRT,activated partial thromboplastin times（APTT）during CRRT and 3 hafter CRRT had significant differences.No difference was found between the values before and 3 hafter CRRT.According to APTT at 2-4 hafter starting CRRT and blood purification tube arteriovenous pressure,argatroban dose had been adjusted for 114 times.APTT after dose adjustment was decreased and showed significant difference compared to APTT at 2-4 hafter starting CRRT（P=0.034）.The incidence of coagulation within the filter and/or the pipeline in the argatroban anticoagulation was 13.85%（55 cycles）.There were 6 cases of bleeding events,including 3 cases of trachea hemorrhage,2 of skin ecchymosis and 1 of gastrointestinal bleeding.There were no hemorrhage symptoms aggravated at decreased dose of argatroban.CONCLUSION APTT has a close correlation with the dose of argatroban.The coagulation parameters recover quickly after CRRT.Small dose argatroban in high risk bleeding patients receiving CRRT has good effect and high security.