Effects of argatroban as an anticoagulant for intermittent veno-venous hemofiltration (IVVH) in patients at high risk of bleeding

BACKGROUND: The critically ill patients with acute renal failure (ARF) undergoing intermittent veno-venous hemofiltration (IVVH) are often at high risk of bleeding. No conventional anticoagulants can adequately achieve this task. Argatroban, a synthetic direct thrombin inhibitor, has been approved for the treatment of hemodialysis patients with antithrombin III deficiency and particularly for heparin-induced thrombocytopenia II patients. Therefore, the anticoagulating effect of argatroban in patients with a high risk of bleeding was investigated. METHODS: One hundred and one ARF patients at high risk of bleeding were treated with predilution IVVH, assigned to a nonheparin group (n = 44) and an argatroban group (n = 57). Venous blood was collected to monitor the change of coagulant parameters pre- and post-IVVH in both groups. Activated partial thromboplastin time (APTT) value was monitored in the argatroban group at different sites and time points to adjust the dosage during IVVH. RESULTS: All the patients in the argatroban group completed treatment successfully, whereas in the nonheparin group, clotting of the extracorporeal circuit occurred in 16.9% of patients. Furthermore, D-dimer increased slightly and platelet counts decreased post-hemofiltration in the nonheparin group. No change was found in platelet counts and coagulant parameters in the argatroban group pre- and post-hemofiltration. Argatroban prolonged the APTT by 50% at the venous site after the initial bolus and the maintenance infusion at 2 and 4 h during the treatment with no change at the arterial site. No major bleeding episodes and serious side effects were found. CONCLUSIONS: In critically ill patients with a high risk of bleeding, argatroban is an effective and safe anticoagulant for IVVH.

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Peer-reviewed research on therapeutic compound development relevant to leech-derived anticoagulants and antithrombotic agents. Indexed in PubMed and verified against the NCBI record.

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