Application Status and Development Direction of Anticoagulant in Continuous Renal Replacement Therapy

Abstract

Abstract: Continuous renal replacement therapy(CRRT) technique is one of the important means of organ support in critical care medicine. Due to its treatment time is significantly longer than intermittent hemodialysi, the requirement for anticoagulation is even more. This paper reviews the current application status of commonly used anticoagulant in CRRT. At present, unfractionated heparin(UFH) remains one of the most commonly used anticoagulant method for domestic CRRT, but its adverse reactions should be paid attention, mainly including high incidence rate of bleeding, heparin-induced thrombocytopenia(HIT), heparin resistance, etc. Compared with heparin, the rate of low molecular weight heparins(LMWH) caused bleeding complications is lower, but the dose is difficult to control and the monitoring method is complex, which limits its wide use. Regional citrate anticoagulation(RCA) is one of the important and promising anticoagulant Methods for CRRT because it's easy to use, and has been testified to extend the life of the filter without systemic anticoagulation danger. In recent years, standardized solution of RCA and preflush formula become a hot spot in the field of citrate anticoagulation.

Key words: continuous renal replacement therapy, anticoagulant, adverse reaction

CLC Number:

R973.2

ZHAO Ying-qi ,GAO Na ,YIN Kai . Application Status and Development Direction of Anticoagulant in Continuous Renal Replacement Therapy [J]. Chinese Journal of Pharmacovigilance, 2013, 10(11): 658-662.

References

[1] Hochart H, Jenkins P V, Preston R J, et al. Concentration-depentent roles for heparin in modifying lipopolysaccharide-induced activation of mononuclear cells in whole blood[J]. Thromb Haemost, 2008,99(3): 570-575.
[2] van de Wetering J, Westendorp R G, van de Hoeven J G, et al.Heparin use in continuous renal replacement procedures: the steuggle between filter coagulation and patient hemorrhage[J]. J Am Soc Nephrol, 1996, 7(1): 145-150.
[3] 马驰骋,芦昌慧,刘爱军,等. 在肝素抗凝的连续肾脏替代治疗中活化部分凝血活酶时间适宜时间的研究[J]. 中国全科医学,2010,13（6）：1993－1996.
[4] Oudenmans-Van Straaten HM,Wester J P, de PontAC, et al. Anticoagulation strategies in continuous renal replacememt therapy:can the choice be evidence based[J].Intensive Care Med, 2006, 32(2): 188-202.
[5] Carr JA, Silverman N. The heparin-protamine interaction. A review[J].J Cardiovase Surg(Torino), 1999, 40(5): 659-666.
[6] 叶朝阳,赵久石,陆石.血液透析管路通路技术及临床应用[Ｍ].上海：复旦大学出版社,2010：212.
[7] 黄馥菡,施向东.100例尿毒症血液透析患者肝素诱导的血小板减少症发病率及临床特点[J].浙江实用医学,2011,16（4）：250-261.
[8] PosadasMA,Hahn D, SchleuterW, et al. Thrombocytopenia associatedwith dialysis treatments[J].Hemodial Int,2011,15(3): 416-423.
[9] 高亚,赵永强,王书杰. 肝素制剂应用患者中血小板减少症的发病率及病因分析[J].中日友好医院学报,2010,24（4）：198-201.
[10] Tsirigotis P, Mantzios G, Makris F, et al. Bilateral renal artery thrombosis due to heparin-induced thrombocytopenia-thrombosis syndrome. Successful treatment with longterm application of lepirudin[J]. Ulster Med, 2006, 75(1): 88-90.
[11] Kannan, Meganathana, Ahmad, et al. Funcional characterization of antibodies against heparin-platelet factor 4 complex in heparininduced thrombocytopenia patients in Asian-Indians: relevance to inflammatory markers[J]. Blood Coagulation & fibrinolysis, 2008,19(6): 471-475.
[12] 卿国忠,尹建亚,张克娜,等. 血液净化并发肝素诱导的血小板减少症临床观察[J].中南医学科学杂志,2013,41（1）：54-57.
[13] Hirsh J, Warkenin T E, Shaughnessy S G, et al. Heparin and low-molecular-weight heparin:mechanisms of action, pharmacokinetics, dosing, monitoring, efficacy, and safety[J]. Chest, 2001, 119(1):64S-94S.
[14] Cohen J R, Sarfati I, Birnbaum E, et al. The inactivation of antithrombinIII byserumelastaseinpatients withsurgical infections [J].Am Surg, 1990, 56(11): 665-667.
[15] GrittersM, Borgdorff P, GrootemanMP, et al. Platelet activation in clinical haemodialysis: LMWH as a major contributor to bio-incompatibility[J].Nephrol Dial Transplant, 2008, 23(9): 2911-2917.
[16] Oudemans-Van Straaten H M, van Schilfgaared M, Molenaar P J,et al. Hemostasis during low molecular weight heparin anticoagulation for continuous venovenous hemofiltration: a randomized cross-over trial comparing two hemofiltrarion rates[J].Crit Care,2009, 13(6): R193.