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Intensive Care Med. 2004 Feb;30(2):260-265. doi: 10.1007/s00134-003-2047-x. Epub 2003 Nov 5.

Citrate vs. heparin for anticoagulation in continuous venovenous hemofiltration: a prospective randomized study.

Author information

1
General Intensive Care and Department of Nephrology, University Hospital, 4000, Liege, Belgium. m.monchi@free.fr.
2
General Intensive Care and Department of Nephrology, University Hospital, 4000, Liege, Belgium.

Abstract

OBJECTIVE:

To compare the efficacy and safety of adjusted-dose unfractionated heparin with that of regional citrate anticoagulation in intensive care patients treated by continuous venovenous hemofiltration (CVVH).

DESIGN AND SETTING:

Prospective, randomized, clinical trial in a 32-bed medical and surgical ICU in a university teaching hospital.

PATIENTS:

ICU patients with acute renal failure requiring continuous renal replacement therapy, without cirrhosis, severe coagulopathy, or known sensitivity to heparin.

INTERVENTIONS:

Before the first CVVH run patients were randomized to receive anticoagulation with heparin or trisodium citrate. Patients eligible for another CVVH run received the other study medication in a cross-over fashion until the fourth circuit.

MEASUREMENTS AND RESULTS:

Forty-nine circuits (hemofilters) were analyzed: 23 with heparin and 26 with citrate. The median lifetime of hemofilters was 70 h (interquartile range 44-140) with citrate anticoagulation and 40 h (17-48) with heparin (p=0.0007). One major bleeding occurred during heparin anticoagulation and one metabolic alkalosis (pH=7.60) was noted with citrate after a protocol violation. Transfusion rates (units of red cells per day of CVVH) were, respectively, 0.2 (0.0-0.4) with citrate and 1.0 (0.0-2.0) with heparin (p=0.0008).

CONCLUSIONS:

Regional citrate anticoagulation seems superior to heparin for the filter lifetime and transfusion requirements in ICU patients treated by continuous renal replacement therapy.

PMID:
14600809
DOI:
10.1007/s00134-003-2047-x
[Indexed for MEDLINE]

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