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Continuous IV Infusion is the Choice Treatment Route for Arginine-vasopressin Receptor Blocker Conivaptan in Mice to Study Stroke-evoked Brain Edema
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Citrate anticoagulation for continuous venovenous hemofiltration.

Heleen M Oudemans-van Straaten1, Rob J Bosman, Matty Koopmans

  • 1Department of Intensive Care Medicine, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands. h.m.oudemans-vanstraaten@olvg.nl

Critical Care Medicine
|December 31, 2008
PubMed
Summary

Citrate regional anticoagulation is safer than nadroparin for continuous venovenous hemofiltration (CVVH), reducing adverse events and mortality. While efficacy was similar, citrate showed unexpected survival benefits, particularly in surgical and sepsis patients.

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09:38

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Published on: January 24, 2012

Area of Science:

  • Nephrology
  • Critical Care Medicine
  • Pharmacology

Background:

  • Continuous venovenous hemofiltration (CVVH) is a critical renal replacement therapy for critically ill patients with acute renal failure.
  • Systemic anticoagulation with heparin poses bleeding risks, while regional citrate anticoagulation has metabolic concerns.
  • Comparing the safety and efficacy of citrate versus heparin anticoagulation in CVVH is crucial for optimizing patient care.

Purpose of the Study:

  • To compare the safety and efficacy of regional citrate anticoagulation versus systemic nadroparin anticoagulation in critically ill patients undergoing CVVH.
  • To evaluate adverse events, bleeding rates, metabolic outcomes, circuit survival, and mortality between the two anticoagulation strategies.

Main Methods:

  • A randomized, nonblinded, controlled single-center trial was conducted in a general intensive care unit.
  • Adult critically ill patients requiring CVVH for acute renal failure and without increased bleeding risk were included.
  • Patients received either regional citrate anticoagulation or systemic anticoagulation with nadroparin.

Main Results:

  • Adverse events requiring discontinuation were significantly lower with citrate (2/97) compared to nadroparin (20/103).
  • Bleeding rates (6 vs. 16 patients) and red blood cell transfusions were similar between groups.
  • Citrate use was associated with less metabolic alkalosis and lower plasma calcium levels. Three-month mortality was significantly reduced with citrate (45% vs. 62%).

Conclusions:

  • Regional citrate anticoagulation is safer than nadroparin for CVVH, with a lower incidence of adverse events.
  • While efficacy was similar, citrate demonstrated an unexpected significant reduction in mortality, particularly in surgical patients, sepsis, and those with severe organ failure.
  • The mortality benefit of citrate may be partly due to reduced bleeding and potentially other mechanisms like anti-inflammatory effects, warranting further investigation.