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Updated: Sep 8, 2025

In Vitro Thrombosis Test for Ventricular Assist Devices
Published on: March 21, 2025
Ionized Calcium Before Venous Bubble Trap Strongly Affects Coagulation When Using Calcium-Containing Dialysate in
Introduction:
Regional citrate anticoagulation (RCA) is highly recommended as an anticoagulation method for intermittent hemodialysis (IHD) in patients at high bleeding risk. Few studies have investigated the effect of ionized calcium (iCa) concentration at different pipeline points on circuit clotting in RCA using calcium-containing dialysate.
Methods:
This prospective study included 185 IHD sessions treated with a two-stage RCA protocol. Ionized calcium levels were measured at different pipeline points. The primary endpoint was severe clotting in the extracorporeal circulation circuit (ECC).
Results:
Sessions with severe circuit clotting showed higher platelet counts, shorter activated partial thromboplastin time, greater dialyzer surface areas, and higher iCa concentrations around venous bubble trap (VBT). Cox regression models revealed that iCa concentration before VBT (per 0.10 mmol/L, hazard ratio (HR) = 1.54, p = 0.006) and baseline platelet count (HR = 1.01, p = 0.02) were strongly associated with severe circuit clotting.
Conclusion:
The iCa concentration before VBT could serve as a key indicator of anticoagulant efficacy in RCA with calcium-containing dialysate.
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