Thromboelastography Applied In Monitoring Anticoagulation In Continuous Renal Replacement Therapy

Objective: Heparin is the primary anticoagulant of blood purification in the world, which is monitored by partial thromboplastin time(APTT). However, risk of hemorrhage and filter life was not ideal. Rapid blood clots elastic graph(Rapid thromboelastograph r TEG) can dynamically monitoring the whole blood coagulation state by clotting factors, platelet and fibrinolytic system function. This study studies that conventional APTT combined rapid thrombosis figure together adjust the dose of heparin to reduce risk of hemorrhage and improve filter life.Methods: This study enroll 40 patients treated with continuous renal replacement therapy(CRRT) from Cangzhou Central Hospital from March, 2014 to December, 2014. Patients with use of anticoagulants, active bleeding, heparin anticoagulant contraindication and liver failure were excluded. The eligible patients were randomly divided into experimental group(APTT combined with r TEG) and control group(APTT). There was no statistical significance in gender, age, weight, APTT, platelet level had(P>0.05). Both groups use the CVVH mode, pre-dilution, replacement fluid volume 2000ml/h, the blood flow of 150ml/min. Filter life as well as hemorrhagic tendency and hemorrhage of skin, nasal mucosa, gingiva, digestive tract and respiratory tract were recorded. When transmembrane pressure reached 300 mm Hg, coagulation alarmed and blood clot in Exhaust pot, treatment was paused. The study compares filter life, the dosage of heparin and incidence of bleeding between the two groups.Result: Filter time was 23.4±3.92 h and 18.5±3.23 h in experimental and control group(P<0.05), while dose of heparin was 17697.5 ±3 255.02 U and 17700.0 ± 4781.96 U respectively(P=0.99). Tendency of hemorrhage was 5% and 12.5%, while incidence of hemorrhage was 4.27/1000 h and 15.97/1000 h respectively.Conclusion: Rapid thromboelastograph can test the whole process of blood clot, analyse whole blood viscoelasticity characteristics in graphics mode and reflects the qualitative analysis of individual cell componentsanalysis the characteristics of the whole blood viscoelasticity. Thereforce, the application of Thrombelastogram monitors coagulation state of continuous renal replacement therapy in patients and responses coagulation function. Thromboelastography can provide the function of platelet. Experimental comparison of heparin enzyme can provide effect of heparin anticoagulant, guide the dose of heparin, prolong filter life, reduces the workload of medical staff, enhance the treatment effect, and reduce bleeding complications. TEG is a practical and effective monitoring method for anticoagulation of continuous renal replacement treatment.