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CN 22-1108/R
Volume 38 Issue 10
Oct.  2022
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Article Navigation >  Journal of Clinical Hepatology  > 2022  >  38(10): 2396-2401

Anticoagulants for artificial liver support therapy: Application advances and selection strategies

DOI: 10.3969/j.issn.1001-5256.2022.10.038

  • Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu 610041, China

Research funding:

1.3.5 Project for Disciplines of Excellence, West China Hospital, Sichuan University (ZYGD20009);

1.3.5 Project for Disciplines of Excellence, West China Hospital, Sichuan University (ZYJC21014)

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  • Corresponding author: BAI Lang, pangbailang@163.com(ORCID: 0000-0001-5042-4336)
  • Received Date: 2022-03-01
  • Accepted Date: 2022-04-08
  • Published Date: 2022-10-20
    Abstract
  • Coagulation disorder is one of the characteristics of liver failure, leading to an unstable and vulnerable "rebalance" state of coagulation function, which may be easily broken by internal or external factors. Anticoagulants are often required during artificial liver support therapy for patients with liver failure, which may break the "rebalance" state and result in bleeding events. This article reviews the methods for evaluating coagulation status in liver failure, the features of available anticoagulants, and the advances in the application of such anticoagulants in artificial liver support therapy and discusses the anticoagulation management and selection strategy for artificial liver support therapy with reference to the selection experience of West China Hospital of Sichuan University.

     

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  • [1]
    Liver Failure and Artificial Liver Group, Chinese Society of Infectious Diseases, Chinese Medical Association; Severe Liver Disease and Artificial Liver Group, Chinese Society of Hepatology, Chinese Medical Association. Guideline for diagnosis and treatment of liver failure(2018)[J]. J Clin Hepatol, 2019, 35(1): 38-44. DOI: 10.3969/j.issn.1001-5256.2019.01.007.

    中华医学会感染病学分会肝衰竭与人工肝学组, 中华医学会肝病学分会重型肝病与人工肝学组. 肝衰竭诊治指南(2018年版)[J]. 临床肝胆病杂志, 2019, 35(1): 38-44. DOI: 10.3969/j.issn.1001-5256.2019.01.007.
    [2]
    LAN XQ, JI YL, CHEN JJ, et al. Effect of artificial liver support therapy on the short-term prognosis of patients with liver failure in the plateau stage: A stratified analysis based on Model for End-Stage Liver Disease score[J]. J Clin Hepatol, 2020, 36(9): 2005-2009. DOI: 10.3969/j.issn.1001-5256.2020.09.019.

    兰小勤, 纪雅丽, 陈金军, 等. 基于MELD评分分层分析人工肝治疗对平台期肝衰竭患者短期预后的影响[J]. 临床肝胆病杂志, 2020, 36(9): 2005-2009. DOI: 10.3969/j.issn.1001-5256.2020.09.019.
    [3]
    National Center for Healthcare Quality Management in Kidney Disease. Blood Purification Standard Operating Procedure (2021 version)[EB/OL]. (2021-11-08)[2022-03-01]. http://www.nhc.gov.cn/yzygj/s7659/202111/6e25b8260b214c55886d6f0512c1e53f.shtml.

    国家肾病学专业医疗质量管理与控制中心. 血液净化标准操作规程(2021年版)[EB/OL]. (2021-11-08)[2022-03-01]. http://www.nhc.gov.cn/yzygj/s7659/202111/6e25b8260b214c55886d6f0512c1e53f.shtml.
    [4]
    MA YJ, BAI L, TANG H. Research progress of the application of regional citrate anticoagulation in artificial liver to treat liver failure[J]. Chin J Hepatol, 2020, 28(6): 532-535. DOI: 10.3760/cma.j.cn501113-20200509-00238.

    马元吉, 白浪, 唐红. 局部枸橼酸抗凝在人工肝治疗肝衰竭中的应用研究进展[J]. 中华肝脏病杂志, 2020, 28(6): 532-535. DOI: 10.3760/cma.j.cn501113-20200509-00238.
    [5]
    MA Y, CHEN F, XU Y, et al. Safety and efficacy of regional citrate anticoagulation during plasma adsorption plus plasma exchange therapy for patients with acute-on-chronic liver failure: a pilot study[J]. Blood Purif, 2019, 48(3): 223-232. DOI: 10.1159/000500408.
    [6]
    ZOU PF, TU MM, DAI XH, et al. Comparison of anticoagulation efficacy and safety between small dose argatroban and low molecular weight heparin applied in Li's artificial liver support system[J]. Chin J Clin Infect Dis, 2019, 12(3): 201-205. DOI: 10.3760/cma.j.issn.1674-2397.2019.03.008.

    邹鹏飞, 屠明敏, 戴霞红, 等. 小剂量阿加曲班与低分子肝素在李氏人工肝治疗中抗凝疗效及安全性比较[J]. 中华临床感染病杂志, 2019, 12(3): 201-205. DOI: 10.3760/cma.j.issn.1674-2397.2019.03.008.
    [7]
    YUAN S, QIAN Y, TAN D, et al. Therapeutic plasma exchange: A prospective randomized trial to evaluate 2 strategies in patients with liver failure[J]. Transfus Apher Sci, 2018, 57(2): 253-258. DOI: 10.1016/j.transci.2018.02.001.
    [8]
    KONG M, LI S, GENG H, et al. Influencing factors of heparin anticoagulant effect in the treatment of double plasma molecular adsorption system[J]. J Capit Med Univ, 2021, 42(4): 647-652. DOI: 10.3969/j.issn.1006-7795.2021.04.022.

    孔明, 李爽, 耿华, 等. 双重血浆分子吸附系统治疗过程中肝素抗凝效果的影响因素研究[J]. 首都医科大学学报, 2021, 42(4): 647-652. DOI: 10.3969/j.issn.1006-7795.2021.04.022.
    [9]
    NIU RZ, XIANG DD, WANG YM, et al. Effects of different anticoagulants on blood coagulation during treatment of severe hepatitis with artificial liver[J]. Chin J Pract Intern Med, 2003, 23(10): 593-595. DOI: 10.3969/j.issn.1005-2194.2003.10.009.

    牛润章, 向德栋, 王宇明, 等. 人工肝治疗重型肝炎时抗凝剂对凝血影响的研究[J]. 中国实用内科杂志, 2003, 23(10): 593-595. DOI: 10.3969/j.issn.1005-2194.2003.10.009.
    [10]
    PANG YL, LI LS, ZHANG ZP, et al. The clinical application of plasma exchange in the treatment with low molecular weight heparins of hepatitis gravis[J]. J Clin Hepatol, 2006, 22(5): 330-332. DOI: 10.3969/j.issn.1001-5256.2006.05.003.

    庞永立, 李来生, 张芝萍, 等. 低分子肝素在人工肝血浆置换治疗重型肝炎中的应用观察[J]. 临床肝胆病杂志, 2006, 22(5): 330-332. DOI: 10.3969/j.issn.1001-5256.2006.05.003.
    [11]
    NILIUS H, KAUFMANN J, CUKER A, et al. Comparative effectiveness and safety of anticoagulants for the treatment of heparin-induced thrombocytopenia[J]. Am J Hematol, 2021, 96(7): 805-815. DOI: 10.1002/ajh.26194.
    [12]
    KELLUM JLAMEIRE NASPELIN P, et al. Kidney disease: Improving global outcomes (KDIGO) acute kidney injury work group. KDIGO clinical practice guideline for acute kidney injury[J]. Kidney Int Suppl, 2012, 2(1): 1-138. DOI: 10.1038/kisup.2012.1
    [13]
    YE T, ZHAO WQ, ZHOU L, et al. Efficacy and safety of in vitro sodium citrate anticoagulation in continuous venovenous hemofiltration[J]. Clin J Med Offic, 2020, 48(4): 415-416, 419. DOI: 10.16680/j.1671-3826.2020.04.19.

    叶婷, 赵文琪, 周露, 等. 枸橼酸钠体外抗凝在连续性静脉-静脉血液过滤中疗效及安全性观察[J]. 临床军医杂志, 2020, 48(4): 415-416, 419. DOI: 10.16680/j.1671-3826.2020.04.19.
    [14]
    LU W, YAN XL, LIU L, et al. Comparison of the effect of local citrate anticoagulation and systemic heparin anticoagulation on CRRT in ARDS patients with AKI[J]. China Med Herald, 2020, 17(32): 152-155. https://www.cnki.com.cn/Article/CJFDTOTAL-YYCY202032040.htm

    陆伟, 燕宪亮, 刘丽, 等. 局部枸橼酸抗凝与全身肝素抗凝在ARDS并发AKI患者CRRT治疗中的效果比较[J]. 中国医药导报, 2020, 17(32): 152-155. https://www.cnki.com.cn/Article/CJFDTOTAL-YYCY202032040.htm
    [15]
    SCHNEIDER AG, JOURNOIS D, RIMMELÉ T. Complications of regional citrate anticoagulation: accumulation or overload?[J]. Crit Care, 2017, 21(1): 281. DOI: 10.1186/s13054-017-1880-1.
    [16]
    KLINGELE M, STADLER T, FLISER D, et al. Long-term continuous renal replacement therapy and anticoagulation with citrate in critically ill patients with severe liver dysfunction[J]. Crit Care, 2017, 21(1): 294. DOI: 10.1186/s13054-017-1870-3.
    [17]
    ZHANG W, BAI M, YU Y, et al. Safety and efficacy of regional citrate anticoagulation for continuous renal replacement therapy in liver failure patients: a systematic review and meta-analysis[J]. Crit Care, 2019, 23(1): 22. DOI: 10.1186/s13054-019-2317-9.
    [18]
    FAYBIK P, HETZ H, MITTERER G, et al. Regional citrate anticoagulation in patients with liver failure supported by a molecular adsorbent recirculating system[J]. Crit Care Med, 2011, 39(2): 273-279. DOI: 10.1097/CCM.0b013e3181fee8a4.
    [19]
    MEIJERS B, LALEMAN W, VERMEERSCH P, et al. A prospective randomized open-label crossover trial of regional citrate anticoagulation vs. anticoagulation free liver dialysis by the Molecular Adsorbents Recirculating System[J]. Crit Care, 2012, 16(1): R20. DOI: 10.1186/cc11180.
    [20]
    SENTVRK E, ESEN F, OZCAN PE, et al. The treatment of acute liver failure with fractionated plasma separation and adsorption system: Experience in 85 applications[J]. J Clin Apher, 2010, 25(4): 195-201. DOI: 10.1002/jca.20238.PMID:20818714.
    [21]
    WANG M, MA Y, DU L, et al. Association between longer duration of citrate accumulation and 90-day mortality of acute-on-chronic liver failure[J]. Crit Care, 2021, 25(1): 387. DOI: 10.1186/s13054-021-03819-8.
    [22]
    SCHNEIDER AG, JOANNES-BOYAU O. Regional citrate anticoagulation for CRRT: Still hesitating?[J]. Anaesth Crit Care Pain Med, 2021, 40(2): 100855. DOI: 10.1016/j.accpm.2021.100855.
    [23]
    JOANNES-BOYAU O, VELLY L, ICHAI C. Optimizing continuous renal replacement therapy in the ICU: a team strategy[J]. Curr Opin Crit Care, 2018, 24(6): 476-482. DOI: 10.1097/MCC.0000000000000564.
    [24]
    van COTT EM, ROBERTS AJ, DAGER WE. Laboratory monitoring of parenteral direct thrombin inhibitors[J]. Semin Thromb Hemost, 2017, 43(3): 270-276. DOI: 10.1055/s-0036-1597297.
    [25]
    YARBROUGH PM, VAREDI A, WALKER A, et al. Argatroban dose reductions for suspected heparin-induced thrombocytopenia complicated by child-pugh class C liver disease[J]. Ann Pharmacother, 2012, 46(11): e30. DOI: 10.1345/aph.1R226.
    [26]
    KITAMURA N, ZHANG L. Nafamostat mesilate in anticoagulation of continuous renal replacement therapy[J]. West China Med J, 2018, 33(7): 801-805. DOI: 10.7507/1002-0179.201806036.

    北村伸哉, 张凌. 甲磺酸萘莫司他在连续性肾脏替代治疗中的抗凝应用[J]. 华西医学, 2018, 33(7): 801-805. DOI: 10.7507/1002-0179.201806036.
    [27]
    MAKINO S, EGI M, KITA H, et al. Comparison of nafamostat mesilate and unfractionated heparin as anticoagulants during continuous renal replacement therapy[J]. Int J Artif Organs, 2016, 39(1): 16-21. DOI: 10.5301/ijao.5000465.
    [28]
    SWARTZ RD, PORT FK. Preventing hemorrhage in high-risk hemodialysis: regional versus low-dose heparin[J]. Kidney Int, 1979, 16(4): 513-518. DOI: 10.1038/ki.1979.157.
    [29]
    BAHL V, HU HM, HENKE PK, et al. A validation study of a retrospective venous thromboembolism risk scoring method[J]. Ann Surg, 2010, 251(2): 344-350. DOI: 10.1097/SLA.0b013e3181b7fca6.
    [30]
    TRITSCHLER T, KRAAIJPOEL N, LE GAL G, et al. Venous thromboembolism: Advances in diagnosis and treatment[J]. JAMA, 2018, 320(15): 1583-1594. DOI: 10.1001/jama.2018.14346.
    [31]
    GOLEMI I, SALAZAR ADUM JP, TAFUR A, et al. Venous thromboembolism prophylaxis using the Caprini score[J]. Dis Mon, 2019, 65(8): 249-298. DOI: 10.1016/j.disamonth.2018.12.005.
    [32]
    ALBERTSEN IE, GOLDHABER SZ, PIAZZA G, et al. Predictors of not initiating anticoagulation after incident venous thromboembolism: A Danish nationwide cohort study[J]. Am J Med, 2020, 133(4): 463-472. DOI: 10.1016/j.amjmed.2019.08.051.
    [33]
    LYU BY, LI Q. Strategies in the evaluation of coagulation status in patients with liver failure[J]. J Clin Hepatol, 2020, 36(4): 928-931. DOI: 10.3969/j.issn.1001-5256.2020.04.049.

    吕滨月, 李谦. 肝衰竭患者的出凝血状态评估策略[J]. 临床肝胆病杂志, 2020, 36(4): 928-931. DOI: 10.3969/j.issn.1001-5256.2020.04.049.
    [34]
    Expert Consensus Group on Diagnosis and Treatment of Acute Hemorrhagic Coagulation Disorders. Expert consensus on diagnosis and treatment of acute hemorrhagic coagulation disorders[J]. Chin J Emerg Med, 2020, 29(6): 780-787. DOI: 10.3760/cma.j.issn.1671-0282.2020.06.007.

    急性出血性凝血功能障碍诊治专家共识组. 急性出血性凝血功能障碍诊治专家共识[J]. 中华急诊医学杂志, 2020, 29(6): 780-787. DOI: 10.3760/cma.j.issn.1671-0282.2020.06.007.
    [35]
    LISMAN T, HERNANDEZ-GEA V, MAGNUSSON M, et al. The concept of rebalanced hemostasis in patients with liver disease: Communication from the ISTH SSC working group on hemostatic management of patients with liver disease[J]. J Thromb Haemost, 2021, 19(4): 1116-1122. DOI: 10.1111/jth.15239.
    [36]
    STRAVITZ RT. Algorithms for managing coagulation disorders in liver disease[J]. Hepatol Int, 2018, 12(5): 390-401. DOI: 10.1007/s12072-018-9886-6.
    [37]
    SCHARF RE. Thrombocytopenia and hemostatic changes in acute and chronic liver disease: pathophysiology, clinical and laboratory features, and management[J]. J Clin Med, 2021, 10(7): 1530. DOI: 10.3390/jcm10071530.
    [38]
    TAPPER EB, ROBSON SC, MALIK R. Coagulopathy in cirrhosis-the role of the platelet in hemostasis[J]. J Hepatol, 2013, 59(4): 889-890. DOI: 10.1016/j.jhep.2013.03.040.
    [39]
    LI XR, MA YJ, BAI L, et al. Recent advances in simple plasma exchange therapy with regional citrate anticoagulation[J]. Chin J Clin Infect Dis, 2021, 14(6): 475-480. DOI: 10.3760/cma.j.issn.1674-2397.2021.06.013.

    李晓冉, 马元吉, 白浪, 等. 局部枸橼酸抗凝在单重血浆置换治疗中的应用研究进展[J]. 中华临床感染病杂志, 2021, 14(6): 475-480. DOI: 10.3760/cma.j.issn.1674-2397.2021.06.013.
    [40]
    XU Y, CHEN F, WANG Y, et al. Nursing care of patients with liver failure undergoing plasma adsorption plus sequential plasma exchange artificial liver model therapy combined with regional citrate anticoagulation[J]. Chin J Integr Tradit West Med Intensive Crit Care, 2019, 26(6): 685-687. DOI: 10.3969/j.issn.1008-9691.2019.06.012.

    许艳, 陈芳, 王颖, 等. 血浆吸附序贯血浆置换人工肝模式治疗肝衰竭应用局部枸橼酸抗凝的护理[J]. 中国中西医结合急救杂志, 2019, 26(6): 685-687. DOI: 10.3969/j.issn.1008-9691.2019.06.012.
    [41]
    AGUILERA IM, VAUGHAN RS. Calcium and the anaesthetist[J]. Anaesthesia, 2000, 55(8): 779-790. DOI: 10.1046/j.1365-2044.2000.01540.x.
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