关键词: 阿加曲班, 低分子肝素, 局部枸橼酸抗凝, 连续性肾脏替代治疗

Abstract:

Ｏｂｊｅｃｔｉｖｅ：To investigate the anticoagulation effect and safety of low dose argatroban combined with citrate when the anticoagulation with low molecular weight heparin (LMWH) and citrate was ineffective in continuous renal replacement therapy (CRRT).
Ｍｅｔｈｏｄｏｌｏｇｙ：From September 2015 to May 2017,twenty CRRT treated AKI patients complicated with risk of bleeding were enrolled in this selfcontrolled，prospective，observational study in ICU of Jinling Hospital (Nanjing,China).The prescription of original anticoagulation therapy was LMWH 20～50 IU/kg at bolus and 5 IU/(kg·h) as maintenance,combined with 13% trisodium citrate 50～60 ml/h.Time to replaced by argatroban 30～50 μg/kg at bolus and 01～03 μg/(kg·min) as maintenance,when the given protocol of LMWH was not enough to maintain the filter life >24h and not to increase the dose of LMWH in case of increase risk of bleeding.The modality of CRRT,type of filter and dose of citrate were not changed during the study.Primary observational outcome was filters′ functional life before/after the switch of anticoagulation therapy.
Ｒｅｓｕｌｔｓ：The median doses of anticoagulants adjusted by body weight were LMWH (352±1043) IU/kg at bolus and (33±089) IU/(kg·h) as maintenance,argatroban adjusted by body weight was (459±1402) μg/kg at bolus and (012±005) μg/(kg·min) as maintenance.The survival analysis of filters life suggested an increasing after LMWH replaced by argatroban (median filter life 140h  vs 480h,P＜0001).And no statistical changes in coagulation status (including APTT、Fg、ATⅢ and Ddimer) after the replacement of anticoagulant.Meanwhile,WBC and PLT were decreased slightly but statistical significantly.No bleeding events and liver function (DBIL,IBIL,ALT and AST) abnormal were recorded by follow up to 72h after the end of CRRT，or to censored.
Ｃｏｎｃｌｕｓｉｏｎ：
The low dose of argatroban combined with citrate will be an appropriate choice to replace LMWH combined with citrate as routine anticoagulation protocal in CRRT.

Key words: argatroban, low molecular weight heparin, regional citrate anticoagulation, continuous renal replacement therapy