A study of anticoagulants for continuous hemodiafiltration(CHDF).

DOI 1 Citations Open Access
  • Ohtake Yoshio
    Department of Emergency and Critical Care Medicine, Chiba University School of Medicine
  • Hirasawa Hiroyuki
    Department of Emergency and Critical Care Medicine, Chiba University School of Medicine
  • Sugai Takao
    Department of Emergency and Critical Care Medicine, Chiba University School of Medicine
  • Oda Shigeto
    Department of Emergency and Critical Care Medicine, Chiba University School of Medicine
  • Shiga Hidetoshi
    Department of Emergency and Critical Care Medicine, Chiba University School of Medicine
  • Nakanishi Kazuya
    Department of Emergency and Critical Care Medicine, Chiba University School of Medicine
  • Matsuda Kenichi
    Department of Emergency and Critical Care Medicine, Chiba University School of Medicine

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  • ｃｏｎｔｉｎｕｏｕｓ　ｈｅｍｏｄｉａｆｉｌｔｒａｔｉｏｎ（ＣＨＤＦ）における抗凝固剤の検討

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Bleeding complications during continuous hemofiltration (CHF) and CHDF constitute a very serious problem. However, nafamostat mesilate (NM), as an anticoagulant, has dramatically reduced the incidence of bleeding complications, and the problem of bleeding complications has been virtually resolved. Recently, CHDF has become the blood purification method of the first choice for acute renal failure and anuric MOF in place of CHF. However, problems other than bleeding complications, such as the necessity for high doses of NM and easy coagulability in the extracorporeal circuit and hemofilter, have been noticed during CHDF. Therefore, the present study was undertaken to investigate differences, in the pharmacokinetics of NM, as an anticoagulant, between CHF and CHDF. The study also investigated the new problem of anticoagulants in CHDF. CHDF, with nafamostat mesilate, was performed on 41 critically ill patients between 1989. 10 and 1991. 5. The dose of nafamostat mesilate during CHDF was 0.29±0.17mg/kg/h, which was significantly larger than that used during CHF. CHDF with NM could be done on 30 patients (70%) without any serious problem. On the other hand, low molecular weight heparin (LMWH) was administered to 4 patients and NM plus LMWH was administered to 11 patients due to the necessity of a high dose of NM (over 0.3mg/kg/h) and/or the easy coagulability of the extracorporeal circuit and hemofilter. The incidences of bleeding complications with these anticoagulation regimens were 25% and 29%, respectively. The high doses of NM were given to 15 patients, including 8 patients with hepatic failure and 2 patients with hemolytic uremic syndrome, to maintain an ACT value over 150 seconds. These results indicate that the dose of NM administered during CHDF was significantly larger than that during CHF and that it was influenced by several factors including the rate of filtration, dialysis and pathophysiological conditions of the patients.

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