Abstract:

Objective: To compare the safety and efficacy of regional citrate plus low dose of low molecular weight heparins (LMWH) with only regional citrate or normal dose of, LMWH for different anticoagulation methods in patients with continuous veno-venuous hemofiltration (CVVH).  Methodology: Fifty seven critically ill patients who requiring CVVH without anticoagulation contraindications were enrolled in this study. They were randomly divided into 3 groups adopting different anticoagulation protocols as following: regional citrate anticoagulation in group A, systemic LMWH in group B [loading dose of LMWH 40IU/kg, maintenance dose 4IU/(kg.h)], and regional citrate plus low dose of LMWH in group C [loading dose 20IU/kg, maintenance dose 2IU/(kg.h)]. The primary outcome was the filter survival time, and the secondary outcome was the change of hemoglobin (Hb), platelet counts (PLT), and anticoagulation-related side effects.  Results: Fifty-three patients completed the study and entered into data analysis, 15 in group A, 19 in group B and 19 in group C. The mean APACHEII scores in each group were 16.2 ± 3.65, 17.11 ± 3.5 and 17.01 ± 4.79, respectively (P>0.05). The filter survival time were 21.2 ± 3.48 hrs in group A, 25.1 ± 5.50 hrs in group B, and 40.4 ± 7.08 hrs in group C (P <0.01). There were 3 patients in each group of A (20%) and B (15.8%) switching to the anticoagulation protocol of group C due to filter life span less than 8 hrs, 4 patients in group B (21%) switching to group C due to bleeding, 3 patients in group A (20%) and 4 patients in group C (21.1%) switching to group B due to citrate related complications. The percentage of patients with reduction of Hb and platelet counts levels was more than 30%, while no differences was found among 3 groups (P>0.05). There were no differences in the CVVH duration, hospital days and ICU days and giving up or death rates between 3 groups.  Conclusion: Compared with anticoagulation using only regional citrate or LMWH, regional citrate plus low dose of LMWH protocol was more efficacy in prolonging filter life span, without significant increase of anticoagulation-related complications.

Key words: continuous renal replacement therapy     citrate   , low molecular weight heparins  , efficacy  , safe