Serum ionised calcium, thrombin time (TT), fibrinogen (FIB) after heparin and sodium citrate anticoagulation in children with sepsis.

Abstract

Background: This study aimed to compare the anticoagulant efficacy and bleeding risk of systemic heparin versus local sodium citrate anticoagulation in continuous renal replacement therapy (CRRT) for children with sepsis in the intensive care unit (ICU).

Methods: Clinical data from 96 children with sepsis admitted to the ICU of Northwest Women's and Children's Hospital between January 2021 and January 2024 were retrospectively analysed. The children were divided into a control group (CG) and an observation group (OG). Coagulation parameters, the effectiveness of blood purification treatment, and the incidence of bleeding events during CRRT were compared between the two groups.

Results: After treatment, significant increases were observed in activated partial thromboplastin time (APTT), prothrombin time (PT), and thrombin time (TT), while fibrinogen (FIB) levels decreased. APTT, PT, and TT showed more significant increases in the OG, and FIB levels were notably reduced. pH, HCO3-, and Na+ levels were significantly different after treatment, and creatinine (Cr) and urea nitrogen (BUN) levels were lower in both groups, with the OG showing a slightly more significant decrease in Cr and BUN compared to the CG. Ionised calcium (iCa2+) levels were higher in the OG than in the CG. The bleeding incidence in the OG was 27.08%, lower than the 35.42% observed in the CG (all P<0.05).

Conclusions: Local sodium citrate anticoagulation demonstrated a favourable anticoagulation effect with a lower bleeding risk than systemic heparin anticoagulation in CRRT for children with sepsis in the ICU.