Dos métodos de anticoagulación en técnicas continuas de depuración extrarrenal

Abstract

Introduction: Continuous extra-renal depuration techniques are the therapy of choice in critically ill patients. But, they are not exempt from complications such as the coagulation of the extracorporeal circuit. The drug traditionally used for anticoagulation is sodium heparin. Although other methods of anticoagulation, such as citrate, are also used.
Objective: To evaluate the efficacy and safety of two anticoagulation methods in patients treated with continuous therapies, in intensive care units of the Hospital Clinic of Barcelona. Material and Method: A retrospective observational study with 54 subjects was carried out. The criteria of acute renal insufficiency, described in the protocol “Guide for renal replacement therapy in acute renal failure at the Hospital Clínic” were applied. Patients were treated by hemodiafiltration, combining convection and diffusion therapies; with filtration fraction < 25%, and effluent dose of 30ml/kg/h. Twenty-seven subjects performed hemodiafiltration, pre-filter replacement and anticoagulation with sodium heparin. The rest, hemodiafiltration, post-filter replacement and anticoagulation with citrate. Episodes of bleeding and duration in hours of the extracorporeal circuits were evaluated during 72 hours of therapy.
Results: Citrate demonstrated a greater survival of filters (95% CI, MD 65, 44.00-72.00 vs. MD 36.00, 15.00-22.00, p=0.02). Patients treated with heparin had more episodes of bleeding, without statistically significant differences (95% CI, n=6 vs. n=9, p=0.537). There was an episode of hypocalcemia in the citrate group, corrected according to protocol. In the heparin group, there were no cases of heparin-induced thrombocytopenia.
Conclusions: The present study demonstrates greater efficacy in the survival of filters in the citrate group.