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

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. Key words: Anticoagulants; Hemofiltration; Risk factors; Argatroban; Renal replacement therapy