title: Effects of argatroban as an anticoagulant for intermittent veno-venous hemofiltration (IVVH) in patients at high risk of bleeding.
abstract: 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.
authors.affiliation: Institute of Nephrology of PLA, Key Laboratory of PLA, Department of Nephrology, General Hospital of PLA, Beijing, People’s Republic of China.
authors.forename: Xuefeng
authors.initials: X
authors.lastname: Sun
authors.forename: Yunshuang
authors.initials: Y
authors.lastname: Chen
authors.forename: Qing
authors.initials: Q
authors.lastname: Xiao
authors.forename: Yong
authors.initials: Y
authors.lastname: Wang
authors.forename: Jianhui
authors.initials: J
authors.lastname: Zhou
authors.forename: Zhifang
authors.initials: Z
authors.lastname: Ma
authors.forename: Jing
authors.initials: J
authors.lastname: Xiang
authors.forename: Xiangmei
authors.initials: X
authors.lastname: Chen
mesh_terms: D058186:Acute Kidney Injury / Q000150:complications / Q000628:therapy*; D000925:Anticoagulants / Q000627:therapeutic use*; D001120:Arginine / Q000031:analogs & derivatives; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006440:Hemofiltration / Q000401:mortality*; D006470:Hemorrhage / Q000209:etiology* / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010875:Pipecolic Acids / Q000627:therapeutic use*; D011379:Prognosis; D011446:Prospective Studies; D017582:Renal Replacement Therapy; D012307:Risk Factors; D013449:Sulfonamides; D015996:Survival Rate
chemical_list: D000925:Anticoagulants; D010875:Pipecolic Acids; D013449:Sulfonamides; D001120:Arginine; C031942:argatroban