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[Anticoagulation in continuous renal replacement therapies (CRRT)].
Erwin Otero Garcés1, Josué Almeida Victorino, Francisco Verisimo Veronese
1Programa de Pós-Graduação em Ciências Médicas, Nefrologia e Serviço de Nefrologia do Hospital de Clínicas de Porto Alegre, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS.
Revista Da Associacao Medica Brasileira (1992)
|October 24, 2007
Summary
Effective anticoagulation is crucial for continuous renal replacement therapies (CRRT) in critically ill patients. Trisodium citrate offers a safe regional anticoagulation option when systemic anticoagulation is contraindicated.
Area of Science:
- Nephrology
- Critical Care Medicine
- Pharmacology
Background:
- Continuous renal replacement therapies (CRRT) are vital for critically ill patients requiring dialysis.
- Successful CRRT hinges on effective anticoagulation to prevent circuit clotting and minimize bleeding complications.
- Dialysis circuit thrombosis can be influenced by pump speed, catheter type, dialyzer membrane, and anticoagulation technique.
Purpose of the Study:
- To review anticoagulation strategies for CRRT.
- To highlight the safety and efficacy of different anticoagulants in critically ill patients.
- To discuss alternatives when standard anticoagulation is not feasible.
Main Methods:
- Review of current anticoagulation protocols used in CRRT.
- Comparison of unfractionated heparin (UFH), low-molecular weight heparins (LMWH), and regional anticoagulation with trisodium citrate.
- Discussion of alternative methods like saline flushing and novel agents.
Main Results:
- Unfractionated heparin (UFH) is widely used, but low-molecular weight heparins (LMWH) are also safe and effective.
- Regional anticoagulation with trisodium citrate is a safe and efficient option for patients with contraindications to systemic anticoagulation, requiring strict metabolic control.
- Regional anticoagulation with UFH/protamine has limited use due to protamine-related side effects.
Conclusions:
- Trisodium citrate provides a valuable regional anticoagulation method for CRRT in specific patient populations.
- Saline flushing is an alternative when heparinization is contraindicated and citrate is unavailable.
- Emerging anticoagulants offer future possibilities for patients with contraindications.
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