肾脏替代治疗期间阿加曲班抗凝发生凝血事件的危险因素分析  

Analysis of risk factors for coagulation events in patients receiving argatroban during renal replacement therapy

作　　者：唐莲[1] 周梦月 庄智伟[3] 陆件[3] 沈奕[3] 许晓文 周琴[1] 薛苏东 虞燕霞[1] Tang Lian;Zhou Mengyue;Zhuang Zhiwei;Lu Jian;Shen Yi;Xu Xiaowen;Zhou Qin;Xue Sudong;Yu Yanxia(Department of Pharmacy, the Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou 215002, China;Colleage of Pharmacy, Xuzhou Medical University, Xuzhou 221004, China;Intensive Care Unit, the Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou 215002, China)

机构地区：[1]南京医科大学附属苏州医院/苏州市立医院药学部,215002 [2]徐州医科大学药学院,221004 [3]南京医科大学附属苏州医院/苏州市立医院重症监护室,215002

出　　处：《药物不良反应杂志》2019年第4期258-264,共7页Adverse Drug Reactions Journal

基　　金：江苏省药学会奥赛康医院药学科研项目(201511).

摘　　要：目的探讨肾脏替代治疗(RRT)期间阿加曲班抗凝发生凝血事件的危险因素。方法收集2015年1月至2017年3月在南京医科大学附属苏州医院/苏州市立医院ICU接受RRT并给予阿加曲班抗凝的高出血风险患者的病历资料进行回顾性分析。结果纳入分析的患者共65例,男性36例,女性29例;年龄(75±20)岁。65例患者共行372个RRT周期,其中72个周期发生凝血事件纳入凝血事件组,余300个周期纳入无凝血事件组。单因素Logistic回归分析显示,RRT下机时血小板计数(OR=0.990,95%CI:0.978~1.001,P=0.084)、血钙水平(OR=5.722,95%CI:2.183~14.999,P<0.001)和阿加曲班首剂量(OR=0.712,95%CI:0.498~1.017,P=0.062)、初始微泵剂量(OR=0.614,95%CI:0.368~1.026,P=0.063)、调整微泵剂量(OR=0.587,95%CI:0.353~0.977,P=0.040)以及下机时跨膜压(OR=1.010,95%CI:1.006~1.014,P<0.001)与凝血事件发生相关。多因素Logistic回归分析显示,RRT下机时血钙水平和跨膜压是发生凝血事件的独立危险因素(OR=4.007,95%CI:1.107~15.793,P=0.047;OR=1.012,95%CI:1.005~1.018,P=0.008)。ROC曲线分析结果显示,下机时血钙>2.6 mmol/L或跨膜压>206 mmHg(1 mmHg=0.133 kPa),发生凝血事件的风险增加。结论RRT下机时血钙水平和跨膜压是RRT期间阿加曲班抗凝发生凝血事件的独立危险因素。Objective To explore the risk factors for coagulation events after argatroban anticoagulation in patients receiving renal replacement therapy (RRT). Methods The medical records of patients at high risk of bleeding, who received RRT combined with argatroban anticoagulation in ICU of the Affiliated Suzhou Hospital of Nanjing Medical University (Suzhou Municipal Hospital) from January 2015 to March 2017, were collected and analyzed retrospectively. Results A total of 65 patients were enrolled, including 36 males and 29 females, aged (75.4±19.7) years. A total of 372 RRT cycles were performed, including 72 cycles in the coagulation events group because of coagulation events occurence and the remaining 300 cycles in the non-coagulation events group. Univariate logistic regression analysis showed that platelet count (OR=0.990, 95%CI: 0.978-1.001, P=0.084) and serum calcium level at the time of finishing RRT (OR=5.722, 95%CI: 2.183-14.999, P<0.001), first dose (OR=0.712, 95%CI: 0.498-1.017, P=0.062), initial micropump dosage (OR=0.614, 95%CI: 0.368-1.026, P=0.063), and adjusted micropump dosage(OR=0.587, 95%CI: 0.353-0.977, P=0.040) of argatroban, and transmembrane pressure at the time of finishing RRT (OR=1.010, 95%CI: 1.006-1.014, P<0.001) were associated with coagulation events. Multivariate logistic regression analysis showed that serum calcium level and transmembrane pressure at the time of finishing RRT were independent risk factors of coagulation events (OR=4.007, 95%CI: 1.107-15.793, P=0.047;OR=1.012, 95%CI: 1.005-1.018, P=0.008). The ROC curve showed that the risk of coagulation events increased when serum calcium level at the time of finishing RRT was more than 2.6 mmol/L or transmembrane pressure at the time of finishing RRT was more than 206 mmHg. Conclusion Serum calcium level and transmembrane pressure at the time of finishing RRT are independent risk factors of coagulation events after argatroban anticoagulation during RRT.

关 键 词：抗凝药 血液滤过 危险因素 阿加曲班 肾脏替代治疗 

分 类 号：R969[医药卫生—药理学]