Anticoagulation for Continuous Renal Replacement Therapy - Heparin or Citrate?

Oudemans-van Straaten, Heleen M.

Heparins are used for anticoagulation of continuous renal replacement therapy circuits. However, heparins cause systemic anticoagulation, increasing the risk of bleeding. Citrate provides regional anticoagulation. However, because citrate is also a buffer, its use is complex. Therefore, the choice between heparin or citrate remains controversial. This article discusses the feasability, safety and efficacy of the two regimes, with specific regard to circuit life, bleeding, inflammation and patient and kidney survival. Randomised studies report similar, or longer, circuit survival with citrate and less bleeding. Unexpectedly, the largest randomised trial to date found that citrate was better tolerated and improved patient and kidney survival. Post hoc analysis indicated that citrate was particularly beneficial in patients after surgery, in those with sepsis or in those with a high degree of organ failure, as well as in younger patients, suggesting that citrate is protective under inflammatory conditions. Heparins may be harmful in the setting of severe organ failure. This issue needs further study.

ANTICOAGULANTS; DRUG efficacy; KIDNEY transplantation; HEPARIN; CITRATES; SURGICAL blood loss; PREOPERATIVE risk factors; MULTIPLE organ failure; THERAPEUTICS

European Critical Care & Emergency Medicine, 2010, Vol 2, p38

2042-7840

Academic Journal