Effects of different anticoagulants on coagulation function in hemodialysis patients

Abstract

Objective To investigate the effect of different anticoagulant drugs on the changes of coagulation index and the incidence of hemorrhage in hemodialysis patients. Methods 40 patients with hemodialysis were selected as study objects, according to the random number table method they were divided into three groups, 20 cases received heparin in A group, 10 cases received low molecular heparin in B group; 10 cases received argatroban in C group.At the same time, 10 healthy persons were selected as control group.The activated glass bead clotting time (gbACT), blood velocity (CR), platelet function (PF), prothrombin fragment 1+ 2 (PF1+ 2) and the surface of platelet alpha granule membrane protein (GMF-140) were observed and analyzed in all patients. Results Compared with the control group, the CR, PF, PF1+ 2 and GMF-140 before taking to machine in A group were significantly increased, which were (31.1±5.5)sig/min, (3.1±0.5), (478.2±74.3)pmol/L, (36.9±6.6)pmol/L, respectively, gbACT was significantly prolonged [(196.1±27.3)s]. In A group, compared with before taking to machine, the CR, PF, PF1+ 2 and the GMF-140 before taking off machine were significantly decreased, which were (10.6±3.2)sig/min, (1.8±0.4), (400.1±85.5)pmol/L, (30.9±6.8)pmol/L, respectively, gbACT was significantly prolonged[(252.5±50.4)s], there were statistically significant differences (F=112.64, 28.38, 81.40, 18.11, 21.63 0.05, all P<0.05); B group compared with the control group, the CR, PF, PF1+ 2 and GMF-140 before taking to machine were significantly increased, which were (29.5±6.6)sig/min, (2.9±1.2), (475.5±97.0)pmol/L, (37.5±7.0)pmol/L, respectively, gbACT was significantly prolonged[(193.9±32.8)s]. In B group, the CR and PF1+ 2 before taking off machine were significantly decreased, which were (22.3±6.8), (407.8±90.3)pmol/L, respectively, gbACT was significantly prolonged [(207.5±31.5)s], there were statistically significant differences (F=9.11, 57.81, 5.99, 16.37, all P<0.05); C group compared with the control group, the CR, PF, PF1+ 2 and GMF-140 before taking to machine were significantly increased, which were (26.1±3.3)sig/min, (2.5±0.5), (443.5±64.1)pmol/L, (32.2±8.3)pmol/L, respectively, before taking off machine, the CR[(23.7±4.1)] was higher than (18.5±3.6) of the control group, there were statistically significant differences (F=11.14, 3.04120.30, 8.63, all P<0.05).40 hemodialysis patients were successfully treated without the occurrence of elevated venous pressure during and after treatment pipeline no or slight residual blood, puncture time and no significant prolongation. Conclusion Unfractionated heparin has strong anti-clotting effect, during and after hemodialysis has greater risk of bleeding, dalteparin has anticoagulant effect, but there is greater risk of bleeding during hemodialysis, the use of argatroban helps to improve the condition of bleeding. Key words: Hemodialysis; Anticoagulant drugs; Heparin; Heparin sodium; Aplus