Thrombin Generation and Platelet Function in ICU Patients Undergoing CVVHD Using Regional Citrate Anticoagulation

Area of Science:

• Critical Care Medicine
• Nephrology
• Hematology

Background:

• Uremic critically ill patients often exhibit complex hemostatic alterations.
• Understanding pro- and anticoagulant status is crucial for managing these patients.

Purpose of the Study:

• To investigate changes in pro- and anticoagulant factors in critically ill patients with acute kidney injury before and during continuous renal replacement therapy (CRRT).
• To assess the impact of CRRT with regional citrate anticoagulation on thrombin generation and platelet function.

Main Methods:

• Prospective enrollment of surgical ICU patients with acute kidney injury undergoing CRRT with regional citrate anticoagulation.
• Thrombin generation assay (TGA) and a thrombomodulin-modified variant were used to evaluate procoagulant activity.
• Multiple electrode aggregometry (MEA) assessed platelet function at baseline and on three consecutive days of CRRT.

Main Results:

• No significant changes in thrombin generation were observed after initiating or during CRRT.
• Endogenous thrombin potential (ETP) ratios were significantly increased in patients compared to healthy donors, indicating a baseline procoagulant state.
• Platelet function, assessed by MEA, remained consistently below reference values throughout the observation period.

Conclusions:

• CRRT with regional citrate anticoagulation did not exacerbate the existing procoagulant shift in critically ill patients.
• Platelet function was persistently reduced, suggesting it did not significantly contribute to the observed hemostatic balance during CRRT.