Abstract
This study was undertaken to investgate the efficacies of and problems associated with the use of LMWH as an anticoagulant during continuous hemofiltration (CHF) and continuous hemodiafiltration (CHDF). The incidences of bleeding complications with LMWH, heparin and nafamostat mesilate (NM) were 32%, 67% and 4%, respectively. The incidence of bleeding with LMWH was significantly lower than that with heparin (p<0.05) and was significantly higher than that with NM (p<0.005). The doses of LMWH did not differ significantly between the cases experiencing bleeding and those that did not. The combined method, using NM and LMWH, allowed for reduction of the dose of NM and extended the lifetime of the hemofilter, although the incidence of bleeding was still high (29%). These results indicate that the first choice of anticoagulant for continuous blood purification is NM and that the combined method might be effective in cases needing a large amount of NM and/or for whom the hemofilter and extracorporeal circuit must often be changed due to clotting problems. However, the lack of a bedside monitoring system to determine the optimal dose of LMWH during continuous blood purification remains a serious problem.
