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.	柯昊贤, 沈玄韬, 余文辉, 等. 肿瘤患者连续性肾脏替代治疗枸橼酸与低分子肝素抗凝效果及预后比较. 中华重症医学电子杂志(网络版), 2017, 3(3): 197-201.
2.	李诚, 朱亚梅, 张静, 等. 低分子肝素对血液透析静脉导管的封管效果与安全性分析. 江苏医药, 2016, 42(5): 616-617.
3.	张旭, 周孟赢, 曹盛吉, 等. 抗 Xa 因子在日间 CRRT 低分子肝素抗凝监测中的临床应用. 大连医科大学学报, 2018, 40(3): 230-233.
4.	郭利涛, 赵小利, 刘昱, 等. 局部柠檬酸与低分子肝素在重症患者连续性肾脏替代治疗中的抗凝效果及其影响因素分析. 中国医药, 2017, 12(11): 1715-1719.
5.	齐中意, 彭湘鹤, 颜璐, 等. 低分子肝素对脓毒血症患者凝血功能和肾功能的影响. 解放军预防医学杂志, 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, 肖军, 等. 比较磺达肝癸钠与依诺肝素预防骨科大手术后静脉血栓栓塞症疗效与安全性的 Meta 分析. 南方医科大学学报, 2013, 33(3): 370-375.
8.	赵曼曼, 周欣, 周虹, 等. 162 例磺达肝癸钠的临床应用分析. 中国临床药理学杂志, 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.	张仲华, 鄢建军. 无肝素连续性肾脏替代治疗体外循环凝血危险因素及护理研究进展. 护理学杂志, 2015, 30(11): 102-106.
11.	陈香美. 血液净化标准操作规程. 北京: 人民军医出版社, 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.	刘翔, 龚德华, 季大玺, 等. 连续性肾脏替代治疗患者体外循环凝血的危险因素及护理研究进展. 中华护理杂志, 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. 柯昊贤, 沈玄韬, 余文辉, 等. 肿瘤患者连续性肾脏替代治疗枸橼酸与低分子肝素抗凝效果及预后比较. 中华重症医学电子杂志(网络版), 2017, 3(3): 197-201.
2. 李诚, 朱亚梅, 张静, 等. 低分子肝素对血液透析静脉导管的封管效果与安全性分析. 江苏医药, 2016, 42(5): 616-617.
3. 张旭, 周孟赢, 曹盛吉, 等. 抗 Xa 因子在日间 CRRT 低分子肝素抗凝监测中的临床应用. 大连医科大学学报, 2018, 40(3): 230-233.
4. 郭利涛, 赵小利, 刘昱, 等. 局部柠檬酸与低分子肝素在重症患者连续性肾脏替代治疗中的抗凝效果及其影响因素分析. 中国医药, 2017, 12(11): 1715-1719.
5. 齐中意, 彭湘鹤, 颜璐, 等. 低分子肝素对脓毒血症患者凝血功能和肾功能的影响. 解放军预防医学杂志, 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, 肖军, 等. 比较磺达肝癸钠与依诺肝素预防骨科大手术后静脉血栓栓塞症疗效与安全性的 Meta 分析. 南方医科大学学报, 2013, 33(3): 370-375.
8. 赵曼曼, 周欣, 周虹, 等. 162 例磺达肝癸钠的临床应用分析. 中国临床药理学杂志, 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. 张仲华, 鄢建军. 无肝素连续性肾脏替代治疗体外循环凝血危险因素及护理研究进展. 护理学杂志, 2015, 30(11): 102-106.
11. 陈香美. 血液净化标准操作规程. 北京: 人民军医出版社, 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. 刘翔, 龚德华, 季大玺, 等. 连续性肾脏替代治疗患者体外循环凝血的危险因素及护理研究进展. 中华护理杂志, 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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