阿加曲班与普通肝素在连续性血液滤过抗凝中的作用比较

孔德华; 郭增; 涂翀昉; 张泽华; 王芳

doi:10.13898/j.cnki.issn.1000-2200.2015.07.007

阿加曲班与普通肝素在连续性血液滤过抗凝中的作用比较

1.
1. 安徽省第二人民医院重症医学科, 安徽合肥 230041;
2.
2. 安徽省第二人民医院医学检验科, 安徽合肥 230041

作者简介: 孔德华(1971-),男,硕士,主治医师.

通讯作者: 张泽华, zhangzehua66@126.com ;

基金项目:

Comparision of anticoagulative effect between argatroban and heparin during the continuous veno-venous hemofiltration

1.
1. ICU, The Second People's Hospital of Anhui, Hefei Anhui 230041, China;
2.
2. Clinical Laboratory, The Second People's Hospital of Anhui, Hefei Anhui 230041, China

Corresponding author: ZHANG Ze-hua, zhangzehua66@126.com ;

摘要: 目的:探讨阿加曲班与普通肝素在连续性静脉-静脉血液滤过(CVVH)治疗中抗凝作用和安全性比较。方法:将40例肾功能不全需行CVVH治疗的患者随机分成阿加曲班组和普通肝素组各20例,分别使用阿加曲班和普通肝素抗凝。检查患者CVVH治疗前后血小板和肾功能,第1、4、8 h、治疗结束前以及治疗结束后1 h的活化部分凝血活酶时间(APTT)。观察治疗过程中管路和滤器凝血情况,监测患者治疗结束后24 h内有无出血事件的发生。结果:CVVH治疗后,普通肝素组血小板数量较治疗前明显下降(PP>0.05);阿加曲班组和普通肝素组APTT在CVVH治疗后1 h和治疗结束前延长时间差异均有统计学意义(PP>0.05),而普通肝素组仍高于治疗前(PPP>0.05)。结论:阿加曲班在CVVH治疗中的抗凝作用与普通肝素效果相当,停药后APTT恢复较快,且对血小板影响较小,安全性高,可能是CVVH治疗中比较理想的抗凝剂。
- 血液滤过 /
- 阿加曲班 /
- 普通肝素 /
- 抗凝
Abstract: Objective:To compare the anticoagulative effects and safety between argatroban and heparin in continuous veno-venous hemofiltration(CVVH) therapy.Methods:Forty renal insufficiency patients were randomly divided into the argatroban group and heparin group(20 cases each group).The argatroban group and heparin group were treated with argatroban and heparin,respectively.The platelet(PLT) and renal function before and after treatment,and activated partial thromboplastin time(APTT)after 1,4 and 8 h of the beginning of treatment,before the end of treatment and after 1h of treatment were detected.The blood coagulation of pipe and filter during treatment,and bleeding after 24 h of the end of treatment were observed.Results:Compared with before treatment,the number of PLT in heparin group decreased dramatically(PP>0.05).The differences of APTT between argatroban group and heparin group after CVVH and before the end of treatment were statistically significant(PP>0.05),but for heparin group,the APPT was still higher than that before treatment(PPP>0.05).Conclusions:The anticoagulative effect of argatroban in CVVH treatment is similar to the heparin,the recovery of CVVH is quick after stopping drug.The argatroban is good effect and high safety,which maybe an ideal anticoagulant in CVVH treatment.
- hemofiltration /
- argatroban /
- heparin /
- anticoagulation

[1]	Swan SK,Hursting MJ.The pharmacokinetics and pharmacodynamics of argatroban:effects of age,gender,and hepatic or renal dysfunction[J].Pharmacotherapy,2000,20(3):318-329.
[2]	陈香美.血液净化标准操作规程(2010版)[M].北京:人民军医出版社,2011:46-47.
[3]	Ota K,Akizawa T,Hirasawa Y,et al.Effects of argatroban as an anticoagulant for haemodialysis in patients with antithrombin Ⅲ deficiency[J].Nephrol Dial Transplant,2003,18(8):1623-1630.
[4]	Tolwani AJ,Wille KM.Anticoagulation for continuous renal replacement therapy[J].Semin Dial,2009,22(2):141-145.
[5]	Warkentin TE.Heparin-induced thrombocytopenia in critically ill patients[J].Semin Thromb Hemost,2015,41(1):49-60.
[6]	Lewis BE,Grassman ED,Wrona L,et al.Novastan anticoagulation during renal stent implant in a patient with heparin-induced thrombocytopenia[J].Blood Coagul Fibrinolysis,1997,8(1):54-58.
[7]	Linkins LA,Dans AL,Moores LK,et al.Treatment and prevention of heparin-induced thrombocytopenia:Antithrombotic Therapy and Prevention of Thrombosis,9th ed:American College of Chest Physicians Evidence-Based Clinical Practice Guidelines[J].Chest,2012,141(2 Suppl):e495S-e530S.
[8]	Jeske WP,Fareed J,Hoppensteadt DA,et al.Pharmacology of argatroban[J].Expert Rev Hematol,2010,3(5):527-539.
[9]	Hantgan RR,Jerome WG,Hursting MJ.No effect of clot age or thrombolysis on argatroban's inhibition of thrombin[J].Blood,1998,92(6):2064-2074.
[10]	Badiye A,Hernandez GA,Chaparro S.Argatroban as novel therapy for suspected thrombosis in patients with continuous-flow left ventricle assist device and hemolysis[J].ASAIO J,2014,60(3):361-365.
[11]	Swan SK,St Peter JV,Lambrecht LJ,et al.Comparison of anticoagulant effects and safety of argatroban and heparin in healthy subjects[J].Pharmacotherapy,2000,20(7):756-770.
[12]	Murray PT,Reddy BV,Grossman EJ,et al.A prospective comparison of three argatroban treatment regimens during hemodialysis in end-stage renal disease[J].Kidney Int,2004,66(6):2446-2453.
[13]	Lewis BE,Wallis DE,Hursting MJ,et al.Effects of argatroban therapy,demographic variables,and platelet count on thrombotic risks in heparin-induced thrombocytopenia[J].Chest,2006,129(6):1407-1416.
[14]	Babuin L,Pengo V.Argatroban in the management of heparin-induced thrombocytopenia[J].Vasc Health Risk Manag,2010,6:813-819.

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阿加曲班与普通肝素在连续性血液滤过抗凝中的作用比较

作者简介: 孔德华(1971-),男,硕士,主治医师.

通讯作者: 张泽华, zhangzehua66@126.com ;

Comparision of anticoagulative effect between argatroban and heparin during the continuous veno-venous hemofiltration

Corresponding author: ZHANG Ze-hua, zhangzehua66@126.com ;

计量

阿加曲班与普通肝素在连续性血液滤过抗凝中的作用比较

通讯作者: 张泽华, zhangzehua66@126.com;

作者简介: 孔德华(1971-),男,硕士,主治医师.

English Abstract

Comparision of anticoagulative effect between argatroban and heparin during the continuous veno-venous hemofiltration

Corresponding author: ZHANG Ze-hua, zhangzehua66@126.com

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留言板

阿加曲班与普通肝素在连续性血液滤过抗凝中的作用比较

作者简介: 孔德华(1971-),男,硕士,主治医师.

通讯作者: 张泽华, zhangzehua66@126.com ;

Comparision of anticoagulative effect between argatroban and heparin during the continuous veno-venous hemofiltration

Corresponding author: ZHANG Ze-hua, zhangzehua66@126.com ;

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出版历程

阿加曲班与普通肝素在连续性血液滤过抗凝中的作用比较

通讯作者: 张泽华, zhangzehua66@126.com;

作者简介: 孔德华(1971-),男,硕士,主治医师.

English Abstract

Comparision of anticoagulative effect between argatroban and heparin during the continuous veno-venous hemofiltration

Corresponding author: ZHANG Ze-hua, zhangzehua66@126.com

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目录