The Safety And Efficacy Of Argatroban And Low-molecular-weight Heparin In Hemodialysis:A Meta-analysis

Background:Hemodialysis remains the most effective method to remove uremic toxins in patients with chronic renal failure.Anticoagulant drugs are needed to ensure the flow of blood in the filter and pipeline in clinical,so that hemodialysis can be carried out smoothly.Heparin and LMWH were used commonly today,which playing an anticoagulant role,it also increase the risk of bleeding.Argatroban is a direct thrombin inhibitor.Studies have shown that argatroban can be play an anticoagulant role in hemodialysis treatment and has a low risk of bleeding.However,because of its high price,argatroban is not yet widely available in clinical,and its effectiveness and safety remain to be studied.Objective:To evaluate the safety and efficacy of argatroban and low-molecular-weight heparin(LMWH)in hemodialysis.Method :PubMed?EMBASE?Cochrane library?CNKI?Wanfang were searched for randomized controlled trials for argatroban and low-molecular-weight heparin in hemodialysis.The literature searched were read by two researchers and determine the final enrolled studies according to the inclusion and exclusion criteria established.Data were extracted from the original literature and RevMan5.3 was used to perform statistical analysis.Jadad scale and funnel plot were used to evaluate the quality and the risk of bias of the included literature.Result: A total of 6 studies were enrolled,including 467 patients(236 in argatroban group,231 in LMWH group).Meta-analysis showed that argatroban group and LMWH group showed no significant difference in clotting events in extracorporeal circuit during the hemodialysis[RR=0.740,95%CI 0.470~1.150,P=0.180],platelet(PLT)counts of argatroban group significantly higher than LMWH group[MD=20.000,95%CI 10.120~29.870),P<0.001],the bleeding rate of argatroban group was significant lower than LMWH group[RR=0.220,95%CI 0.070~0.680,P=0.009],the point of puncture ligature time of argatroban group was significant shorter than LMWH group[MD=-1.350,95%CI-1.850~—0.840,P<0.001].Conclusion:Argatroban and LMWH have the equally effects in clotting events in extracorporeal circuit during the hemodialysis,and argatroban seems more safer than LMWH for less influence on platelet,lower bleeding rate and shorter puncture point ligature time.