Investigation of optimal ACT value during continuous hemodiafiltration using nafamostat mesilate

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  • Yamasaki Tatsumi
    Department of Medical Equipment Center, University of Miyazaki Faculty of Medicine
  • Oda Yuuichi
    Department of Medical Equipment Center, University of Miyazaki Faculty of Medicine
  • Yano Takeshi
    Department of Intensive Care, University of Miyazaki Faculty of Medicine
  • Taniguchi Masahiko
    Department of Intensive Care, University of Miyazaki Faculty of Medicine
  • Shirasaka Tetsuro
    Department of Anesthesiology, University of Miyazaki Faculty of Medicine

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Other Title
  • Nafamostat mesilateを用いた持続的血液濾過透析施行中の至適ACTの検討
  • Nafamostat mesilate オ モチイタ ジゾクテキ ケツエキ ロカ トウセキ シコウ チュウ ノ シテキ ACT ノ ケントウ

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<p>Nafamostat mesilate (NM) was a first-choice drug used as an anticoagulant in continuous hemodiafiltration (CHDF) in our hospital. Activated clotting time (ACT) is an index of the dose of NM. The standard value of ACT is undecided, and blood coagulation in the circuit is occasionally observed. The purpose of this study was to investigate the optimal ACT value for continuous hemodiafiltration using NM. Forty-seven adult patients with scheduled CHDF using NM were included in this study. The ACT value of the outlet site (H-ACT) in the circuit of the hemofiltration device and the ACT value of arterial blood (A-HCT) were measured. There are significant differences (P＜ 0.001) in the H-ACT values between the group (346±94.1s) that continued hemodiafiltration for more than 48 hours and the group（261±92.5s）that stopped hemodiafiltration within 48 hours due to occlusion in the dialysis circuit. These results suggest that a higher H-ACT value lowers the risk of occlusion in the circuit. As analyzed by receiver operating characteristic (ROC) analysis, the cut-off value for the achievement of CHDF was 271 sec (specificity 69.6%, sensitivity 85.1%). These results suggest that H-ACT values of more than 271 sec are appropriate. </p>

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