Low Dose of Argatroban Saline Flushes Anticoagulation in Hemodialysis Patients With High Risk of Bleeding

Abstract

Background: Anticoagulation in hemodialysis (HD) patients with high risk of bleeding is still an intractable problem. Method: A total of 80 HD sessions with high risk of bleeding were completed with either heparin-free (HF) or low dose of argatroban saline flushes (LASF) anticoagulation. Clinical clot formation in the pipeline and dialyzer was inspected to evaluate the local anticoagulation efficiency; prothrombin time (PT), activated partial thromboplastin time (aPTT), and D-dimer were tested to investigate the influence on the whole body coagulation system; urea reduction ratio (URR) and Kt/V were used to evaluate the efficiency of dialysis. Results: Comparing with HF, LASF showed a satisfactory efficiency in reducing the clot formation and the URR and Kt/V of it were also higher. Conclusions: Low dose of argatroban saline flushes is a feasible and safe alternative anticoagulation protocol in HD patients with high risk of bleeding.

Keywords

hemodialysis blood purification anticoagulation argatroban bleeding hemorrhage

References

Symes J. Low molecular weight heparins in patients with renal insufficiency. CANNT J. 2008,18(2):55-61.

Kindgen-Milles D. , Amman J. , Kleinekofort W. , Morgera S. Treatment of metabolic alkalosis during continuous renal replacement therapy with regional citrate anticoagulation. Int J Artif Organs. 2008;31(4):363-366.

Gubensek J. , Buturovic-Ponikvar J. , Ponikvar R. Regional citrate anticoagulation for single-needle hemodialysis: a prospective clinical study. Blood Purif. 2007;25(5-6): 454-456.

Garcés EO , Victorino JA , Veronese FV Anticoagulation in continuous renal replacement therapies (CRRT). Rev Assoc Med Bras. 2007 ;53(5):451-455.

Swartz RD , Port FK Preventing hemorrhage in high risk hemodialysis: regional versus low-dose heparin. Kidney Int. 1979;16(4):513-518.

Pöschel KA , Bucha E. , Esslinger HU , et al. Anticoagulant efficacy of PEG-Hirudin in patients on maintenance hemodialysis. Kidney Int. 2004;65:666-674.

Daugirdas JT Simplified equations for monitoring Kt/V, PCRn, eKt/V, and ePCRn. Adv Ren Replace Ther. 1995 ;2(4):295-304.

Zhang P. , Li CM , Zhang W. , et al. Heparin-free high volume venovenous hemofiltration treatment for perioperative patients of orthotopic liver transplantation. Nephrol Dial Transplant. 2006;21(8):373-373.

Zerbi S. , Pedrini LA Anticoagulation and chronic hemodialysis. G Ital Nefrol. 2007;24(5):381-395.

10.

Sagedal S. , Hartmann A. , Osnes K. , et al. Intermittent saline flushes during haemodialysis do not alleviate coagulation and clot formation in stable patients receiving reduced doses of dalteparin. Nephrol Dial Transplant. 2006 ;21(2):444-449.

11.

DeEugenio DL , Ruggiero NJ , Thomson LJ , Menajovsky LB , Herman JH Early-onset heparin-induced thrombocytopenia after a 165-day heparin-free interval: case report and review of the literature . Pharmacotherapy. 2005;25(4):615-619.

12.

Escolar G. , Bozzo J. , Maragall S. Argatroban: a direct thrombin inhibitor with reliable and predictable anticoagulant actions. Drugs Today (Barc). 2006;42(4):223-236.

13.

Boggio LN , Oza VM Argatroban use in heparin-induced thrombocytopenia. Expert Opin Pharmacother. 2008; 9(11):1963-1967.

14.

Reddy BV , Nahlik L. , Trevino S. , Murray PT Argatroban anticoagulation during renal replacement therapy. Blood Purif. 2002;20(3):313-314.

15.

Yeh RW , Jang IK Argatroban: update. Am Heart J. 2006;151(6):1131-1138.

16.

Murray PT , Reddy BV , Grossman EJ , et al. A prospective comparison of three argatroban treatment regimens during hemodialysis in end-stage renal disease. Kidney Int . 2004;66:2446-2453.

17.

Hursting MJ , Murray PT Argatroban anticoagulation in renal dysfunction: a literature analysis. Nephron Clin Pract. 2008;109(2):C80-C94.

18.

Freyburger G. , Trillaud H. , Labrouche S. , Gauthier P. , Javorschi S. , Grenier N. Rapid ELISA D-dimer testing in the exclusion of venous thromboembolism in hospitalized patients. Clin Appl Thromb Hemost. 2000;6(2): 77-81.

19.

Ng KF , Lam CC , Chan LC In vivo effect of hemodilution with saline on coagulation: a randomized controlled trial. Br J Anaesth. 2002;88(4):475-480.

20.

Young G. , Yonekawa KE , Nakagawa PA , Blain RC , Lovejoy AE , Nugent DJ Recombinant activated factor VII effectively reverses the anticoagulant effects of heparin, enoxaparin, fondaparinux, argatroban, and bivalirudin ex vivo as measured using thromboelastography. Blood Coagul Fibrinolysis . 2007;18(6):547-553.

21.

Schusterschitz N. , Bellmann R. , Stein M. , Dunzendorfer S. , Pechlaner C. , Joannidis M. Influence of continuous veno-venous hemofiltration on argatroban clearance in a patient with septic shock. Intensive Care Med. 2008;34:1350-1351.