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Citrate vs. heparin for anticoagulation in continuous venovenous hemofiltration: a prospective randomized study
Mehran Monchi1, Denis Berghmans2, Didier Ledoux2
1General Intensive Care and Department of Nephrology, University Hospital, 4000, Liege, Belgium. m.monchi@free.fr.
Intensive Care Medicine
|November 6, 2003
Summary
Regional citrate anticoagulation significantly extends filter life and reduces transfusion needs compared to heparin during continuous venovenous hemofiltration in ICU patients. This makes citrate a potentially superior option for renal replacement therapy.
Area of Science:
- Critical Care Medicine
- Nephrology
- Pharmacology
Background:
- Continuous venovenous hemofiltration (CVVH) is vital for acute renal failure in ICUs.
- Effective anticoagulation is crucial for CVVH circuit longevity and patient safety.
- Heparin and regional citrate anticoagulation are common strategies with distinct profiles.
Purpose of the Study:
- To compare the efficacy and safety of adjusted-dose unfractionated heparin versus regional citrate anticoagulation.
- To evaluate the impact on filter lifetime and transfusion requirements in ICU patients undergoing CVVH.
Main Methods:
- Prospective, randomized clinical trial in a mixed medical/surgical ICU.
- Patients with acute renal failure requiring CVVH were randomized to heparin or citrate.
- A cross-over design was used for subsequent CVVH circuits within the same patients.
Main Results:
- Regional citrate anticoagulation resulted in a significantly longer median filter lifetime (70 hours) compared to heparin (40 hours).
- Citrate anticoagulation was associated with lower transfusion rates (0.2 units/day) versus heparin (1.0 units/day).
- One major bleeding event occurred with heparin; one metabolic alkalosis with citrate (protocol violation).
Conclusions:
- Regional citrate anticoagulation demonstrates superior performance regarding filter longevity.
- Citrate anticoagulation leads to reduced transfusion requirements in CVVH patients.
- Citrate appears to be a more effective anticoagulation strategy than heparin for CVVH in the ICU.