在肝衰竭患者的 CRRT 中,区域性枸橼酸盐抗凝剂与 LMWH 抗凝剂的比较不会增加出血风险。

IF 1.4 4区 医学 Q4 ENGINEERING, BIOMEDICAL
Siyan Tang, Yan Yu, Siwei Tang, Tong Liu, Hao Wu, Yi Liu, Lijuan Zhao, Rui Lu, Peng Zhang, Ming Bai
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引用次数: 0

摘要

背景:肝衰竭(LF)患者持续肾脏替代治疗(CRRT)中不增加出血风险的最佳抗凝方案仍存在争议。因此,我们开展了一项单中心回顾性研究,以评估在不增加出血风险的情况下,肝衰竭患者 CRRT 中区域性枸橼酸盐抗凝(RCA)与低分子量肝素(LMWH)抗凝的有效性和安全性:根据 CRRT 的抗凝策略,将患者分为 RCA 组和 LMWH 抗凝组。评估终点为患者存活率、滤器寿命、出血量、枸橼酸盐蓄积量以及总钙/离子钙比值:结果:RCA 组和 LMWH 组分别使用了 167 和 164 个滤器。RCA 组的中位滤器寿命明显更长(34 小时(IQR = 24-54)对 24 小时(IQR = 18-45.5)[95%CI,24.5-33];P = 0.006)。在多变量 COX 回归模型中调整重要参数后,RCA 组的死亡风险显著降低(HR = 0.668 [95%CI, 0.468-0.955]; p = 0.027)。LMWH 组观察到 30 次出血(24.19%),而 RCA 组仅有 7 次(5.34%)(P 结论:LMWH 组的出血风险明显降低:在接受 CRRT 的 LF 患者中,RCA 显著延长了过滤器的使用寿命,并提高了患者的存活率。两组患者的不良事件发生率无明显差异。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Regional citrate anticoagulation versus LMWH anticoagulation for CRRT in liver failure patients without increased bleeding risk.

Background: The optimal anticoagulation regimen for continuous renal replacement therapy (CRRT) in liver failure (LF) patients without increased bleeding risk remains controversial. Therefore, we conducted a monocentric retrospective study to evaluate the efficacy and safety of the regional citrate anticoagulation (RCA) versus low molecular weight heparin (LMWH) anticoagulation for CRRT in LF without increased bleeding risk.

Method: According to the anticoagulation strategy for CRRT, patients were divided into the RCA and LMWH-anticoagulation groups. The evaluated endpoints were patient survival, filter lifespan, bleeding, citrate accumulation, and totCa/ionCa ratio.

Result: Totally 167 and 164 filters were used in the RCA and LMWH group, respectively. The median filter lifespan was significantly longer in the RCA group (34 h (IQR = 24-54) versus 24 h (IQR = 18-45.5) [95%CI, 24.5-33]; p < 0.001). The 4-week mortality rate was significantly higher in the LMWH-anticoagulation group (71 (57.72%) vs 53 (40.46%); p = 0.006). After adjusted the important parameters in the multivariate COX regression model, the mortality risk was significantly reduced in the RCA group (HR = 0.668 [95%CI, 0.468-0.955]; p = 0.027). In the LMWH group, 30 bleeding episodes (24,19%) were observed, whereas only 7 (5.34%) occurred in the RCA group (p < 0.001). Two patients (1.5%) in the RCA group occurred citrate accumulation.

Conclusions: In LF patients without increased bleeding risk who underwent CRRT, RCA significantly extended the filter lifespan and improved patient survival rate. There was no significant difference in the rate of adverse events between the two groups.

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来源期刊
International Journal of Artificial Organs
International Journal of Artificial Organs 医学-工程:生物医学
CiteScore
3.40
自引率
5.90%
发文量
92
审稿时长
3 months
期刊介绍: The International Journal of Artificial Organs (IJAO) publishes peer-reviewed research and clinical, experimental and theoretical, contributions to the field of artificial, bioartificial and tissue-engineered organs. The mission of the IJAO is to foster the development and optimization of artificial, bioartificial and tissue-engineered organs, for implantation or use in procedures, to treat functional deficits of all human tissues and organs.
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