Regional citrate anticoagulation versus no-anticoagulation for continuous venovenous hemofiltration in patients with liver failure and increased bleeding risk: A retrospective case-control study
Regional citrate anticoagulation versus no-anticoagulation for continuous venovenous hemofiltration in patients with liver failure and increased bleeding risk: A retrospective case-control study
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区域柠檬酸盐抗凝与不抗凝治疗肝功能衰竭和出血风险增加患者的连续静脉静脉血液滤过：一项回顾性病例对照研究
DOI：
10.1371/journal.pone.0232516
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发表时间：
2020-05
期刊：
影响因子：
3.7
通讯作者：
Sun Shiren
中科院分区：
文献类型：
--
作者：
Yu Yan;Bai Ming;Ma Feng;Zhang Wei;Li Yangping;Zhao Lijuan;Li Li;Zhou Meilan;Li Lu;Sun Shiren
目的在肝功能衰竭(LF)合并出血风险增加的患者中，连续性静脉-静脉血液滤过(CVVH)的抗凝治疗仍存在争议。因此，我们进行了一项回顾性研究，以评价局部柠檬酸盐抗凝(RCA)与非抗凝治疗这些患者CVVH的有效性和安全性。方法将入选患者根据接受的CVVH抗凝方案分为RCA组和非抗凝组。评估结果包括滤器寿命、出血、柠檬酸蓄积、导管堵塞和总钙/离子钙比值。结果在原始队列中，RCA组(41例，79个滤器)的滤器寿命明显长于非抗凝组(62例，162个滤器)(72hvs39.5h，IQR31.2~47.8h，P=0.002)。校正结果显示，RCA可显著降低滤过失败的风险(HR=0.459，95%CI0.26~0.82，P=0.008)。RCA组共发生4次TotCa/IonCa&Gt；2.5次，在减少柠檬酸剂量和血流量后继续接受RCA-CVVH。在这些患者中没有观察到明显的柠檬酸蓄积。在匹配的队列中，RCA组的滤器寿命也显著长于未抗凝组(P=0.013)。两组间TOTCa/IonCa&Gt2.5发生率差异无统计学意义(P=0.074)。在原始队列和匹配队列中，出血、酸中毒、碱中毒和导管堵塞的发生率在两组之间没有显著差异。结论对于有较高出血风险的LF患者行CVVH，RCA可延长滤器的使用寿命，在严密监测血气和调整柠檬酸盐剂量的前提下，可安全使用。进一步的前瞻性、随机化、对照研究是必要的，以获得可靠的证据。
Objective There are controversial opinions on anticoagulation for continuous venovenous hemofiltration (CVVH) in patients with liver failure (LF) and increased bleeding risk. Therefore, we conducted a retrospective study to evaluate the efficacy and safety of regional citrate anticoagulation (RCA) versus no-anticoagulation for CVVH in these patients. Methods The included patients were divided into RCA and no-anticoagulation group according to the CVVH anticoagulation strategy they accepted for CVVH. Filter lifespan, bleeding, citrate accumulation, catheter occlusion, and totCa/ionCa ratio were evaluated as outcomes. Results In the original cohort, the filter lifespan of the RCA group (41 patients, 79 filters) was significantly longer than the no-anticoagulation group (62 patients, 162 filters) (> 72 hours vs 39.5 hours (IQR 31.2–47.8), P = 0.002). The adjusted results demonstrated that RCA could significantly reduce the risk of filter failure (HR = 0.459, 95%CI 0.26–0.82, P = 0.008). Four episodes of totCa/ionCa > 2.5 were observed in the RCA group and continuously accepted RCA-CVVH after the reduction of citrate dose and blood flow. No obvious citrate accumulation was observed in these patients. In the matched cohort, the filter lifespan of the RCA group was significantly longer than the no-anticoagulation group (P = 0.013) as well. No significant difference in the episodes of totCa/ionCa > 2.5 was observed between the two matched groups (P = 0.074). Both in the original cohort and the matched cohort, the bleeding, acidosis, alkalosis, and catheter occlusion incidences were not significantly different between the two groups. Conclusions In LF patients with increased bleeding risk who underwent CVVH, RCA could prolong the filter lifespan and be safely used with careful blood gas monitoring and citrate dose adjusting. Further prospective, randomized, control studies are warranted to obtain robust evidences.
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影响因子：
5.5
作者：
通讯作者：
--
DOI：
10.1186/cc9358
发表时间：
2011-01-24
期刊：
Critical care (London, England)
影响因子：
--
作者：
Oudemans-van Straaten HM;Kellum JA;Bellomo R
通讯作者：
Bellomo R
影响因子：
25.7
作者：
通讯作者：
--
DOI：
10.2215/cjn.03610417
发表时间：
2018-01-06
影响因子：
9.8
作者：
Allegretti, Andrew S.;Parada, Xavier Vela;Thadhani, Ravi I.
通讯作者：
Thadhani, Ravi I.
影响因子：
8.8
作者：
Meier-Kriesche, HU;Gitomer, J;DuBose, T
通讯作者：
DuBose, T