Evaluation of anticoagulant effect of fondaparinux and low molecular weight heparin in continuous renal replacement therapy_West China Medical Journal

Authors：

TANG Xue , DU Yuanchen ,  CHEN Zhiwen , HE Xuanchen , ZHENG Yi , HE Yingying , WANG Fang , SUN Xiankun , LIN Li

Department of Nephrology, West China Hospital, Sichuan University / West China School of Nursing, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding?author：

CHEN Zhiwen, Email: kiyuhot@163.com

Keywords：

Fondaparinux; low molecular weight heparin; continuous renal replacement therapy; anticoagulation

DOI：

10.7507/1002-0179.202206019

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Objective To investigate the safety and efficacy of two different anticoagulation regimens of fondaparinux and low molecular weight heparin (LMWH) in continuous renal replacement therapy (CRRT). Methods The clinical data of patients undergoing CRRT in West China Hospital of Sichuan University between October 2021 and April 2022 were retrospectively analyzed. The patients were divided into fondaparinux sodium group and LMWH group according to anticoagulation with fondaparinux or LMWH during CRRT. The general condition, life expectancy of cardiopulmonary bypass, coagulation events, bleeding events, hemoglobin, and coagulation function-related indicators were compared between the two groups. Results A total of 78 patients were finally included, including 38 in the LMWH group and 40 in the fondaparinux group. The age of the patients in the LMWH group was older than that in the fondaparinux group [76.0 (57.0, 85.0) vs. 63.0 (52.3, 76.0) years, P=0.016]. There was no significant difference in other clinical baseline conditions (including gender, vascular access site, and treatment indications) between the two groups (P≥0.05). The cardiopulmonary bypass life of patients in the fondaparinux group was better than that in the LMWH group [67.1 (35.0, 72.0) vs. 42.0 (20.0, 55.3) h, P=0.003]. The survival rate of cardiopulmonary bypass in the fondaparinux group at 24, 48, and 72 h were higher than that in the LMWH group (87.5% vs. 65.8%, P=0.023; 67.5% vs. 36.8%, P=0.007; 42.5% vs. 13.2%, P=0.004). The incidence of blood filter coagulation events in the fondaparinux group was lower than that in the LMWH group (50.0% vs. 84.2%, P=0.001). There was no significant difference in the incidence of coagulation events and mild bleeding events between the two groups (P>0.05). There was no significant difference in hemoglobin and coagulation function-related indicators between the two groups before and after CRRT (P>0.05). Conclusion The continuity of maintenance therapy with fondaparinux is better than that of LMWH, and the safety of both in the course of CRRT treatment is comparable.

Citation： TANG Xue, DU Yuanchen, CHEN Zhiwen, HE Xuanchen, ZHENG Yi, HE Yingying, WANG Fang, SUN Xiankun, LIN Li. Evaluation of anticoagulant effect of fondaparinux and low molecular weight heparin in continuous renal replacement therapy. West China Medical Journal, 2023, 38(1): 51-55. doi: 10.7507/1002-0179.202206019 Copy

1.	柯昊賢, 沈玄韜, 余文輝, 等. 腫瘤患者連續性腎臟替代治療枸櫞酸與低分子肝素抗凝效果及預后比較. 中華重癥醫學電子雜志(網絡版), 2017, 3(3): 197-201.
2.	李誠, 朱亞梅, 張靜, 等. 低分子肝素對血液透析靜脈導管的封管效果與安全性分析. 江蘇醫藥, 2016, 42(5): 616-617.
3.	張旭, 周孟贏, 曹盛吉, 等. 抗 Xa 因子在日間 CRRT 低分子肝素抗凝監測中的臨床應用. 大連醫科大學學報, 2018, 40(3): 230-233.
4.	郭利濤, 趙小利, 劉昱, 等. 局部檸檬酸與低分子肝素在重癥患者連續性腎臟替代治療中的抗凝效果及其影響因素分析. 中國醫藥, 2017, 12(11): 1715-1719.
5.	齊中意, 彭湘鶴, 顏璐, 等. 低分子肝素對膿毒血癥患者凝血功能和腎功能的影響. 解放軍預防醫學雜志, 2018, 36(1): 84-86, 106.
6.	Hanna EB, Glancy DL, Saucedo JF. Antiplatelet and anticoagulant therapies in acute coronary syndromes. Cardiovasc Drugs Ther, 2010, 24(1): 61-70.
7.	李虎, 王健, 肖軍, 等. 比較磺達肝癸鈉與依諾肝素預防骨科大手術后靜脈血栓栓塞癥療效與安全性的 Meta 分析. 南方醫科大學學報, 2013, 33(3): 370-375.
8.	趙曼曼, 周欣, 周虹, 等. 162 例磺達肝癸鈉的臨床應用分析. 中國臨床藥理學雜志, 2019, 35(15): 1681-1682, 1715.
9.	Baldwin I, Fealy N. Nursing for renal replacement therapies in the intensive care unit: historical, educational, and protocol review. Blood Purif, 2009, 27(2): 174-181.
10.	張仲華, 鄢建軍. 無肝素連續性腎臟替代治療體外循環凝血危險因素及護理研究進展. 護理學雜志, 2015, 30(11): 102-106.
11.	陳香美. 血液凈化標準操作規程. 北京: 人民軍醫出版社, 2010: 43-49.
12.	Pham PA, Pham PT, Pham PC, et al. Implications of bleeding in acute coronary syndrome and percutaneous coronary intervention. Vasc Health Risk Manag, 2011, 7: 551-567.
13.	Kim IB, Fealy N, Baldwin I, et al. Insertion side, body position and circuit life during continuous renal replacement therapy with femoral vein access. Blood Purif, 2011, 31(1/2/3): 42-46.
14.	Holt AW, Bierer P, Glover P, et al. Conventional coagulation and thromboelastograph parameters and longevity of continuous renal replacement circuits. Intensive Care Med, 2002, 28(11): 1649-1655.
15.	劉翔, 龔德華, 季大璽, 等. 連續性腎臟替代治療患者體外循環凝血的危險因素及護理研究進展. 中華護理雜志, 2013, 48(4): 377-379.
16.	Kidney Disease: Improving Global Outcomes (KDIGO). Acute Kidney Injury Work Group: KDIGO clinical practice guideline for acute kidney injury. Kidney Int, 2012(Suppl 2): 1-138.

1. 柯昊賢, 沈玄韜, 余文輝, 等. 腫瘤患者連續性腎臟替代治療枸櫞酸與低分子肝素抗凝效果及預后比較. 中華重癥醫學電子雜志(網絡版), 2017, 3(3): 197-201.
2. 李誠, 朱亞梅, 張靜, 等. 低分子肝素對血液透析靜脈導管的封管效果與安全性分析. 江蘇醫藥, 2016, 42(5): 616-617.
3. 張旭, 周孟贏, 曹盛吉, 等. 抗 Xa 因子在日間 CRRT 低分子肝素抗凝監測中的臨床應用. 大連醫科大學學報, 2018, 40(3): 230-233.
4. 郭利濤, 趙小利, 劉昱, 等. 局部檸檬酸與低分子肝素在重癥患者連續性腎臟替代治療中的抗凝效果及其影響因素分析. 中國醫藥, 2017, 12(11): 1715-1719.
5. 齊中意, 彭湘鶴, 顏璐, 等. 低分子肝素對膿毒血癥患者凝血功能和腎功能的影響. 解放軍預防醫學雜志, 2018, 36(1): 84-86, 106.
6. Hanna EB, Glancy DL, Saucedo JF. Antiplatelet and anticoagulant therapies in acute coronary syndromes. Cardiovasc Drugs Ther, 2010, 24(1): 61-70.
7. 李虎, 王健, 肖軍, 等. 比較磺達肝癸鈉與依諾肝素預防骨科大手術后靜脈血栓栓塞癥療效與安全性的 Meta 分析. 南方醫科大學學報, 2013, 33(3): 370-375.
8. 趙曼曼, 周欣, 周虹, 等. 162 例磺達肝癸鈉的臨床應用分析. 中國臨床藥理學雜志, 2019, 35(15): 1681-1682, 1715.
9. Baldwin I, Fealy N. Nursing for renal replacement therapies in the intensive care unit: historical, educational, and protocol review. Blood Purif, 2009, 27(2): 174-181.
10. 張仲華, 鄢建軍. 無肝素連續性腎臟替代治療體外循環凝血危險因素及護理研究進展. 護理學雜志, 2015, 30(11): 102-106.
11. 陳香美. 血液凈化標準操作規程. 北京: 人民軍醫出版社, 2010: 43-49.
12. Pham PA, Pham PT, Pham PC, et al. Implications of bleeding in acute coronary syndrome and percutaneous coronary intervention. Vasc Health Risk Manag, 2011, 7: 551-567.
13. Kim IB, Fealy N, Baldwin I, et al. Insertion side, body position and circuit life during continuous renal replacement therapy with femoral vein access. Blood Purif, 2011, 31(1/2/3): 42-46.
14. Holt AW, Bierer P, Glover P, et al. Conventional coagulation and thromboelastograph parameters and longevity of continuous renal replacement circuits. Intensive Care Med, 2002, 28(11): 1649-1655.
15. 劉翔, 龔德華, 季大璽, 等. 連續性腎臟替代治療患者體外循環凝血的危險因素及護理研究進展. 中華護理雜志, 2013, 48(4): 377-379.
16. Kidney Disease: Improving Global Outcomes (KDIGO). Acute Kidney Injury Work Group: KDIGO clinical practice guideline for acute kidney injury. Kidney Int, 2012(Suppl 2): 1-138.

West China Medical Journal

Evaluation of anticoagulant effect of fondaparinux and low molecular weight heparin in continuous renal replacement therapy

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