Efectos del argatrobán como anticoagulante para la hemofiltración venovenosa intermitente (IVVH) en pacientes con alto riesgo de sangrado

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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El resumen se deja sin traducir para conservar la redacción original de los autores.

101 pacientes con alto riesgo hemorrágico sometidos a hemofiltración venovenosa intermitente se asignaron a un grupo sin heparina (n = 44) o con argatrobán (n = 57). Con argatrobán todos completaron el tratamiento, sin cambios en plaquetas ni coagulación, sin sangrados mayores y con el TTPa venoso prolongado un 50 % tras el bolo y la perfusión; sin heparina se coaguló el circuito en el 16,9 %. Los autores concluyen que el argatrobán es un anticoagulante eficaz y seguro.

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