Anticoagulant effectiveness and safety evaluation of a modified heparin anticoagulant method in children treated with hemoperfusion
10.3969/j.issn.1008-9691.2023.05.014
- VernacularTitle:改良肝素抗凝方案在儿童血液灌流治疗中的抗凝效果及安全性评价
- Author:
Shenghua ZHANG
1
;
Hui GUO
;
Xiuying CHEN
Author Information
1. 四川大学华西第二医院小儿肾脏科,四川成都 610041;四川大学华西护理学院,四川成都 610041;出生缺陷与相关妇儿疾病教育部重点实验室,四川成都 610041
- Keywords:
Hemoperfusion;
Blood purification;
Heparin;
Anticoagulation
- From:
Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care
2023;30(5):588-591
- CountryChina
- Language:Chinese
-
Abstract:
Objective To examine the anticoagulant effectiveness and safety of a modified heparin anticoagulant method with those of the standard hepair anticoagulant method in children treated with hemoperfusion,and to provide a basis for optimizing the anticoagulant protocol of hemoperfusion treatment.Methods Twenty-three children treated with a total of 41 sessions of hemoperfusion from June 2021 to February 2022 in Department of Pediatric Nephrology of West China Second Hospital of Sichuan University were selected as research objects by convenient sampling method.The participants were divided into a standard anticoagulation group and an improved anticoagulation method group according to the different heparin-anticoagulation schemes.A total of 11 children in the standard anticoagulation group received 19 sessions of hemoperfusion treatment using the standard heparin anticoagulation scheme,i.e,the first dose of 0.5-1.0 mg/kg heparin was given intravenously,5-10 minates before hemoperfusion,followed by continuous intravenous infusion of 0.2-0.5 mg·kg-1·h-1 heparin which was expected to be stopped 30 minutes before the ending of hemoperfusion.A total of 12 patients in the improved anticoagulation method group underwent 22 sessions of hemoperfusion treatment using an improved heparin anticoagulant method,i.e,intravenous injection 1 mg/kg of heparin before the start of treatment without additional administrations of heparin thereafter.The changes in activated partial thromboplastin time(APTT)at 30,60,90 minutes,and the end of treatment in two groups of children,as well as the coagulation status of the two groups of pipelines and filters,together with the bleeding situation of the children,were monitored.The differences in platelet count(PLT)and recovery of APTT 1 hour after treatment between the two groups of children were compared.Results Compared with the standard anticoagulation method,the improved anticoagulation method showed 68.8%lower APTT value exceeding 300 seconds[β =-1.166,odds ratio(OR)= 0.312,95%confidence interval(95%CI)was 0.125-0.775,P = 0.012]was safer than standard method,and both of them showed good anticoagulation effects at 30,60,90 minutes,and at the end of treatment.The anticoagulation effect of heparin was not influenced by sex(P = 0.179)as well as age(P = 0.821).The improved anticoagulation method group showed better APTT recovery 1 hour after treatment than the standard anticoagulation group(11/22 vs.3/19,P＜0.05).Both anticoagulation methods did not show any coagulation in the pipeline or filter during the treatment process,and the patient did not experience active bleeding within 24 hours after the end of treatment.Conclusion The improved anticoagulant method can achieve anticoagulant effectiveness comparable to that of standard anticoagulation method,is safer than standard method,and at the same time,simplifies the operational process,thereby could reduce the risk of blood borne infections.
