Influencing factors of heparin anticoagulant effect in the treatment of double plasma molecular adsorption system

doi:10.3969/j.issn.1006-7795.2021.04.022

Abstract

Abstract: Objective To observe the anticoagulant effect and safety of empirical heparin anticoagulant regimen in the treatment of double plasma molecular adsorption system (DPMAS), and analyze the factors influencing the anticoagulant effect. Methods A total of 102 patients with liver disease treated by DPMAS in our hospital from April 2018 to December 2020 were selected, 198 times in total. According to the anticoagulation effect of heparin in the course of DPMAS treatment, they were divided into good anticoagulation group, insufficient anticoagulation group and excessive anticoagulation group. The proportion of cases with good anticoagulation effect in different dosage groups were compared, and the differences of baseline clinical data among the three groups were compared. Results There were 118 cases in good anticoagulation group, 11 cases in insufficient anticoagulation group and 69 cases in excessive anticoagulation group.When prothrombin activity (PTA)>30% and platelet (PLT)≤325×10⁹/L, the anticoagulant effect of heparin was good, and the proportion of cases was more than 70%. The body weight, hemoglobin(Hb) and PLT levels of patients with poor anticoagulation were significantly higher than those of patients with good anticoagulation (P<0.05). Compared with the good anticoagulant group, the levels of PTA, antithrombin activity(AT) and Hb in the excessive anticoagulant group were significantly lower, while the levels of PT and activated partial thromboplastin time(APTT) were significantly higher (P<0.05). Within 24 hours after 198 times of treatment, 9 patients had bleeding at the central venous catheter, 1 patient had nasal bleeding, and no other serious bleeding complications such as gastrointestinal bleeding occurred.The APTT level of heparin overdose group was (54.52±19.71)s at 24 hours after treatment, which was not significantly different from that before treatment. Conclusion When PTA>30% and PLT≤325×10⁹/L, it is feasible to give different doses of heparin according to PTA and PLT levels within 24 hours before treatment, but the influence of body weight and hemoglobin on anticoagulant effect should be considered.

Key words: liver, artificial, double plasma adsorption system, heparin, anticoagulants

CLC Number:

R575

Kong Ming, Li Shuang, Geng Hua, Zhou Li, Xu Manman, Liu Jing, Chen Yu. Influencing factors of heparin anticoagulant effect in the treatment of double plasma molecular adsorption system[J]. Journal of Capital Medical University, 2021, 42(4): 647-652.

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URL: https://journal03.magtech.org.cn/Jweb_sdykdxxb/EN/10.3969/j.issn.1006-7795.2021.04.022

https://journal03.magtech.org.cn/Jweb_sdykdxxb/EN/Y2021/V42/I4/647

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