Effects of argatroban as an anticoagulant for intermittent veno-venous hemofiltration (IVVH) in patients at high risk of bleeding.

Abstract

BACKGROUND:

The critically ill patients with acute renal failure (ARF) undergoing intermittent veno-venous hemofiltration (IVVH) are often at high risk of bleeding. No conventional anticoagulants can adequately achieve this task. Argatroban, a synthetic direct thrombin inhibitor, has been approved for the treatment of hemodialysis patients with antithrombin III deficiency and particularly for heparin-induced thrombocytopenia II patients. Therefore, the anticoagulating effect of argatroban in patients with a high risk of bleeding was investigated.

METHODS:

One hundred and one ARF patients at high risk of bleeding were treated with predilution IVVH, assigned to a nonheparin group (n = 44) and an argatroban group (n = 57). Venous blood was collected to monitor the change of coagulant parameters pre- and post-IVVH in both groups. Activated partial thromboplastin time (APTT) value was monitored in the argatroban group at different sites and time points to adjust the dosage during IVVH.

RESULTS:

All the patients in the argatroban group completed treatment successfully, whereas in the nonheparin group, clotting of the extracorporeal circuit occurred in 16.9% of patients. Furthermore, D-dimer increased slightly and platelet counts decreased post-hemofiltration in the nonheparin group. No change was found in platelet counts and coagulant parameters in the argatroban group pre- and post-hemofiltration. Argatroban prolonged the APTT by 50% at the venous site after the initial bolus and the maintenance infusion at 2 and 4 h during the treatment with no change at the arterial site. No major bleeding episodes and serious side effects were found.

CONCLUSIONS:

In critically ill patients with a high risk of bleeding, argatroban is an effective and safe anticoagulant for IVVH.

• Authors: Xuefeng Sun, Yunshuang Chen, Qing Xiao, Yong Wang, Jianhui Zhou, Zhifang Ma, Jing Xiang, Xiangmei Chen
• Journal: Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association (Nephrol Dial Transplant) Vol. 26 Issue 9 Pg. 2954-9 (Sep 2011) ISSN: 1460-2385 [Electronic] England
• PMID: 21303963 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Anticoagulants
• Pipecolic Acids
• Sulfonamides
• Arginine
• argatroban

Topics

• Acute Kidney Injury (complications, therapy)
• Anticoagulants (therapeutic use)
• Arginine (analogs & derivatives)
• Cohort Studies
• Female
• Follow-Up Studies
• Hemofiltration (mortality)
• Hemorrhage (etiology, prevention & control)
• Humans
• Male
• Middle Aged
• Pipecolic Acids (therapeutic use)
• Prognosis
• Prospective Studies
• Renal Replacement Therapy
• Risk Factors
• Sulfonamides
• Survival Rate