Modified regional citrate anticoagulation is optimal for hemodialysis in patients at high risk of bleeding: a prospective randomized study of three anticoagulation strategies
Modified regional citrate anticoagulation is optimal for hemodialysis in patients at high risk of bleeding: a prospective randomized study of three anticoagulation strategies
复制标题
改良局部柠檬酸盐抗凝是出血高风险患者血液透析的最佳选择：三种抗凝策略的前瞻性随机研究
DOI：
10.1186/s12882-019-1661-y
复制
发表时间：
2019-12-19
期刊：
影响因子：
2.3
通讯作者：
Liang, Xinling
中科院分区：
文献类型：
--
作者：
Lin, Ting;Song, Li;Liang, Xinling
背景：推荐的生理盐水冲洗对有肝素禁忌症的高危出血血液透析（HD）患者临床无效。区域柠檬酸抗凝剂（RCA）以前与含Ca2+的透析液和预过滤的柠檬酸一起使用（RCA- 1）。然而，抗凝并不总是能够实现，高达40%的抗凝导致静脉扩张室严重凝血。在本研究中，我们将四分之一的TSC从预滤波器转移到基于rca - 1的后滤波器，我们称之为rca - 2。本研究的目的是比较rca - 2与生理盐水冲洗或rca - 1在HD高危出血患者中的疗效和安全性。方法在这项研究者发起的、多中心、对照、前瞻性、随机临床试验中，52例HD患者（77次）在试验的第一部分随机分为RCA-2和rca - 1组，45例患者（64次）在试验的第二部分随机分为RCA-2和生理盐水组。记录严重凝血事件、不良事件和血液分析。结果rca - 2组严重凝血事件发生率显著低于rca - 1组和生理盐水组（分别为7.89%∶30.77%，P= 0.011; 3.03%∶54.84%，P< 0.001）。rca - 2组的中位循环生存时间为240 min (IQR 240 ~ 240)，显著长于rca - 1组的230 min （IQR 155 ~ 240，P< 0.001）和生理盐水组的210 min （IQR 135 ~ 240，P= 0.003）。ae以低血压、低血糖、胸闷为主，且多为轻度。rca - 1组8例（20.51%），生理盐水组4例（12.90%），rca - 2组10例（26.31%），P < 0.05。结论改良抗凝方案在高危出血患者血液透析治疗中更为有效和可行。试验注册编号：drec， GDREC2017250H。2018年2月2日注册；回顾注册。
BackgroundRecommended regular saline flushing presents clinical ineffectiveness for hemodialysis (HD) patients at high risk of bleeding with heparin contraindication. Regional citrate anticoagulation (RCA) has previously been used with a Ca2+containing dialysate with prefiltered citrate in one arm (RCA-one). However, anticoagulation is not always achievable and up to 40% results in serious clotting in the venous expansion chamber. In this study, we have transferred one-quarter of the TSC from the prefiltered to the post filter based on RCA-one, which we have called RCA-two. The objective of this study was to compare the efficacy and safety of RCA-two with either saline flushing or RCA-one in HD patients with a high bleeding risk.MethodIn this investigator-initiated, multicenter, controlled, prospective, randomized clinical trial, 52 HD patients (77 sessions) were randomized to the RCA-2 and RCA-one group in part one of the trial, and 45 patients (64 sessions) were randomized to the RCA-2 and saline group in part two of the trial. Serious clotting events, adverse events and blood analyses were recorded.ResultsSerious clotting events in the RCA-two group were significantly lower compared with the RCA-one and saline group (7.89% vs. 30.77%,P= 0.011; 3.03% vs. 54.84%,P< 0.001, respectively). The median circuit survival time was 240 min (IQR 240 to 240) in the RCA-two group, was significantly longer than 230 min (IQR 155 to 240,P< 0.001) in the RCA-one group and 210 min (IQR 135 to 240,P= 0.003) in the saline group. The majority of the AEs were hypotension, hypoglycemia and chest tightness, most of which were mild in intensity. Eight patients (20.51%) in the RCA-one group, 4 patients (12.90%) in the saline group and 10 patients (26.31%) in the RCA-two group,P> 0.05.ConclusionsOur data demonstrated that the modified anticoagulation protocol was more effective and feasible during hemodialysis therapy for patients at high risk of bleeding.Trial registrationGDREC, GDREC2017250H. Registered February 2, 2018; retrospectively registered.