Anticoagulation strategies in continuous renal replacement therapy

Matthieu Legrand; Ashita Tolwani

doi:10.1111/sdi.12959

Anticoagulation strategies in continuous renal replacement therapy

Semin Dial. 2021 Nov;34(6):416-422. doi: 10.1111/sdi.12959. Epub 2021 Mar 8.

Authors

Matthieu Legrand^{1

2}, Ashita Tolwani³

Affiliations

¹ Department of Anesthesia and Perioperative Care, Division of Critical Care Medicine, UCSF School of Medicine, San Francisco, CA, USA.
² INI-CRCT Network, Nancy, France.
³ Department of Internal Medicine, Division of Nephrology, University of Alabama at Birmingham, Birmingham, AL, USA.

PMID: 33684244
DOI: 10.1111/sdi.12959

Abstract

The most common anticoagulant options for continuous renal replacement therapy (CRRT) include unfractionated heparin (UFH), regional citrate anticoagulation (RCA), and no anticoagulation. Less common anticoagulation options include UFH with protamine reversal, low-molecular weight heparin (LMWH), thrombin antagonists, and platelet inhibiting agents. The choice of anticoagulant for CRRT should be determined by patient characteristics, local expertise, and ease of monitoring. The Kidney Disease Improving Global Outcomes (KDIGO) acute kidney injury guidelines recommend using RCA rather than UFH in patients who do not have contraindications to citrate and are with or without increased risk of bleeding. Monitoring should include evaluation of the anticoagulant effect, circuit life, filter efficacy, and complications.

Keywords: anticoagulation; citrate; continuous renal replacement therapy.

Publication types

Review

MeSH terms

Acute Kidney Injury* / therapy
Anticoagulants* / therapeutic use
Continuous Renal Replacement Therapy*
Heparin* / therapeutic use
Heparin, Low-Molecular-Weight / therapeutic use
Humans
Renal Dialysis
Renal Replacement Therapy*

Substances

Anticoagulants
Heparin, Low-Molecular-Weight
Heparin