The curative effect comparison between argatroban and heparin anticoagulant in continuous blood purification treatment / 中国中西医结合急救杂志

ABSTRACT

Objective To observe the anticoagulant efficacy and safety of argatroban and unfractionated heparin (UFH) in continuous blood purification (CBP) treatment and provide the theoretical basis for optimizing the anticoagulant mode of CBP treatment in critically ill patients. Methods Sixty patients treated with CBP in Binhai Hospital of General Hospital of Tianjin Medical University from September 2015 to October 2016 were enrolled, and they were divided into two groups by random number table method, each group 30 cases. Before CBP therapy, the patients in argatroban group were treated with argatroban for anti-coagulation, the first dose was 250 μg/kg, the additional dose was 1 μg·kg-1·min-1 continuously infused before sustained filtration, and 20-30 minutes before the end of the CBP treatment, the dose added was stopped; the patients in UFH group were treated with UFH before CBP treatment, the first dose was 0.3-0.5 mg/kg, the additional dose was 5-10 mg/h, and 30 minutes before the end of CBP treatment the dose added was stopped. The changes of activated partial thromboplastin time (APTT) were monitored, before and after the end of CBP treatment, the coagulation of blood in the CBP filter/circuit and bleeding tendency of patients in two groups were observed, and the differences in platelet (PLT) counts were compared between the two groups before and after CBP treatment. Results The APTT of the two groups were significantly longer at 3 hours after treatment and before the end of treatment than those before treatment [UFH group (s): 64.96±7.35, 64.33±6.27 vs. 37.77±5.23; argatroban group (s):70.19±6.18, 72.03±6.39 vs. 40.10±5.11], and at 1 hour after the end of treatment, APTT basically returned to baseline level in argatroban group (s: 39.6±5.06), while in the UFH group APTT was still higher than that before treatment (s: 64.17±6.59). There were no statistical significant differences in the blood coagulation score of the CBP filter/circuit and bleeding score and gradation of patients between the two groups (both P > 0.05). After treatment the PLT levels of the two groups were significantly lower than those before treatment, but the level of PLT in the argatroban group was significantly higher than that in the UFH group (×109/L: 192.20±50.05 vs. 160.00±57.12, P < 0.05). Conclusion In comparison, argatroban has a better anticoagulant effect in CBP treatment for critically ill patients, argatroban is superior to UFH in controllability, so that using the former one can lower the incidence of thrombocytopenia and risk of bleeding.