PDF(Pubmed)
Abstract：
There remains no optimal anticoagulation protocol for continuous renal replacement therapy (CRRT) with regional citrate anticoagulation (RCA) in pediatric patients with elevated D-dimer levels. We aimed to assess the effects of different anticoagulation strategies on the risk of CRRT filter clotting in these patients. Pediatric patients undergoing CRRT were retrospectively grouped based on pre-CRRT D-dimer levels and anticoagulant: D-RCA group (normal D-dimer, RCA only, n = 22), D+ RCA group (elevated D-dimer, RCA only, n = 50), and D+ RCA+ systemic heparin anticoagulation (SHA) group (elevated D-dimer, RCA combined with SHA, n = 55). The risk of filter clotting and incidence of bleeding were compared among the groups. Among the groups, the D+ RCA+ SHA group had the longest filter lifespan; further, the incidence of bleeding was not increased by concurrent use of low-dose heparin for anticoagulation. Moreover, concurrent heparin anticoagulation was associated with a decreased risk of filter clotting. Contrastingly, high pre-CRRT hemoglobin and D-dimer levels and post-filter ionized calcium level > 0.4 mmol/L were associated with an increased risk of filter clotting. RCA combined with low-dose heparin anticoagulation could reduce the risk of filter clotting and prolong filter lifespan without increasing the risk of bleeding in patients with elevated D-dimer levels undergoing CRRT.
摘要：
对于D-二聚体水平升高的儿科患者，仍然没有最佳的抗凝方案用于连续肾脏替代治疗（CRRT）和局部柠檬酸抗凝（RCA）。我们旨在评估不同抗凝策略对这些患者CRRT过滤器凝血风险的影响。接受CRRT的儿科患者根据CRRT前D-二聚体水平和抗凝剂进行回顾性分组：D-RCA组（D-二聚体正常，仅限RCA,n=22),D+RCA组（D-二聚体升高，仅限RCA,n=50),D+RCA+全身肝素抗凝(SHA)组(D-二聚体升高,RCA与SHA相结合，n=55）。比较各组的滤器凝血风险和出血发生率。在群体中，D+RCA+SHA组过滤器寿命最长；此外，同时使用低剂量肝素抗凝治疗并没有增加出血的发生率.此外，同时肝素抗凝与滤器凝血风险降低相关.相反，高的CRRT前血红蛋白和D-二聚体水平以及>0.4mmol/L的滤器后离子钙水平与滤器凝血风险增加相关.RCA联合小剂量肝素抗凝能降低D-二聚体水平升高的CRRT患者凝血风险，延长滤器寿命，且不增加出血风险。
