Examination of Activated clotting time (ACT) at the time of Continuous hemodiafiltration (CHDF) enforcement

Abstract

In the field of emergency and intensive care medicine, continuous hemodiafiltration (CHDF) is the major treatment modality for acute blood purification. In most cases, nafamostat mesilate (NM) is used as an anticoagulant to prevent dialyzer clotting during CHDF. However, mixed results have been obtained in terms of prevention of clotting by NM. So far, there are few reports concerning how to adjust NM dosage by checking the activated clotting time (ACT) of the dialyzer circuit. In this study, we examined the ACT of the arterial inflow line and the venous return line simultaneously during CHDF using NM. Among cases in which clotting did not occur, the optimal ACT was checked. The ACT of the arterial inflow line and the venous return line were as follows: in the group in which the dialyzer was exchanged at 24 hours, 170 seconds and 444 seconds, respectively; in the group in which the dialyzer was exchanged at 48 hours, 176 seconds and 470 seconds, respectively; in the group in which clotting did not occur over 72 hours, 190 seconds and 443 seconds, respectively. The ACT of the venous return line showed no significant differences between all groups. However, in the group in which clotting did not occur over 72 hours, the ACT of the arterial inflow line was significantly prolonged. No bleeding complication was seen in all cases. Based on these results, we recommend controlling the ACT of the arterial side around 170 seconds to prevent dialyzer clotting over 24 hours during CHDF using NM.