关键词: 连续性肾脏替代治疗, 出血, 局部枸橼酸抗凝, 甲磺酸萘莫司他, 阿加曲班

Abstract: In critically ill patients, continuous renal replacement therapy (CRRT) provides indispensable support by continuously removing solutes, precisely regulating fluid volume with balance, and maintaining homeostasis. However, for patients at high risk of bleeding-such as those with active bleeding, liver failure, or coagulation disorders- anticoagulation strategy poses a major challenge: how to balance filter lifespan against bleeding risk. On the one hand, while anticoagulants can extend filter lifespan, they may increase the risk of bleeding complications; on the other hand, although an anticoagulant⁃free approach avoids drug⁃related bleeding, it inevitably leads to shortened filter lifespan. Currently, commonly used clinical anticoagulation strategies include regional citrate anticoagulation, nafamostat mesilate, argatroban, and non⁃anticoagulation, each differing in mechanism, clinical applicability, and safety profile. This review aims to evaluate the efficacy and safety of these strategies in CRRT for high⁃bleeding⁃risk patients, thereby providing an evidence⁃based reference for clinical practice.