scholarly journals Minimizing hemorrhagic complications in dialysis patients.

1991 ◽  
Vol 2 (5) ◽  
pp. 961-975 ◽  
Author(s):  
J W Lohr ◽  
S J Schwab
Keyword(s):  
Renal Failure ◽  
Bleeding Risk ◽  
Bleeding Complications ◽  
Regional Citrate Anticoagulation ◽  
Dialysis Patients ◽  
Citrate Anticoagulation ◽  
Risk Of Bleeding ◽  
Alternative Means ◽  
Clinical Strategy ◽  
Biochemical Abnormalities

Renal failure is associated with an increased incidence of hemorrhage from a variety of sites, particularly in patients undergoing surgical procedures. The primary factors in the pathogenesis of bleeding in renal failure are platelet biochemical abnormalities and alterations in platelet vessel wall interactions. Hemodialysis improves hemostatic abnormalities in uremia, but the need for heparinization during the procedure may increase the bleeding risk. The risk of bleeding may be minimized by using peritoneal dialysis or alternative means to routine heparinization to prevent clotting in the extracorporeal circulation during hemodialysis. These include use of minimal heparin, prostacyclin, regional citrate anticoagulation, and no anticoagulation. Continuous arteriovenous hemodialysis may also be performed with regional citrate anticoagulation. There are several nondialytic therapies that may be used to prevent or treat hemorrhage in renal failure patients. These include administration of cryoprecipitate, 1-deamino-8-arginine vasopressin, estrogens, red blood cells, and erythropoietin. A clinical strategy to minimize bleeding complications in dialysis patients is presented.

scholarly journals Modified regional citrate anticoagulation is optimal for hemodialysis in patients at high risk of bleeding: a prospective randomized study of three anticoagulation strategies

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Ting Lin ◽  
Li Song ◽  
Renwei Huang ◽  
Ying Huang ◽  
Shuifu Tang ◽  
...  
Keyword(s):  
High Risk ◽  
Randomized Study ◽  
Bleeding Risk ◽  
Saline Group ◽  
Regional Citrate Anticoagulation ◽  
Expansion Chamber ◽  
Citrate Anticoagulation ◽  
Risk Of Bleeding ◽  
Group 4 ◽  
High Bleeding Risk

Abstract Background Recommended regular saline flushing presents clinical ineffectiveness for hemodialysis (HD) patients at high risk of bleeding with heparin contraindication. Regional citrate anticoagulation (RCA) has previously been used with a Ca2+ containing dialysate with prefiltered citrate in one arm (RCA-one). However, anticoagulation is not always achievable and up to 40% results in serious clotting in the venous expansion chamber. In this study, we have transferred one-quarter of the TSC from the prefiltered to the post filter based on RCA-one, which we have called RCA-two. The objective of this study was to compare the efficacy and safety of RCA-two with either saline flushing or RCA-one in HD patients with a high bleeding risk. Method In this investigator-initiated, multicenter, controlled, prospective, randomized clinical trial, 52 HD patients (77 sessions) were randomized to the RCA-2 and RCA-one group in part one of the trial, and 45 patients (64 sessions) were randomized to the RCA-2 and saline group in part two of the trial. Serious clotting events, adverse events and blood analyses were recorded. Results Serious clotting events in the RCA-two group were significantly lower compared with the RCA-one and saline group (7.89% vs. 30.77%, P = 0.011; 3.03% vs. 54.84%, P < 0.001, respectively). The median circuit survival time was 240 min (IQR 240 to 240) in the RCA-two group, was significantly longer than 230 min (IQR 155 to 240, P < 0.001) in the RCA-one group and 210 min (IQR 135 to 240, P = 0.003) in the saline group. The majority of the AEs were hypotension, hypoglycemia and chest tightness, most of which were mild in intensity. Eight patients (20.51%) in the RCA-one group, 4 patients (12.90%) in the saline group and 10 patients (26.31%) in the RCA-two group, P > 0.05. Conclusions Our data demonstrated that the modified anticoagulation protocol was more effective and feasible during hemodialysis therapy for patients at high risk of bleeding. Trial registration GDREC, GDREC2017250H. Registered February 2, 2018; retrospectively registered.

scholarly journals Modified regional citrate anticoagulation is optimal for hemodialysis in patients at high risk of bleeding: A prospective randomized study of three anticoagulation strategies

2019 ◽  
Author(s):  
Ting Lin ◽  
Li Song ◽  
Renwei Huang ◽  
Ying Huang ◽  
Shuifu Tang ◽  
...  
Keyword(s):  
High Risk ◽  
Randomized Study ◽  
Bleeding Risk ◽  
Saline Group ◽  
Regional Citrate Anticoagulation ◽  
Expansion Chamber ◽  
Citrate Anticoagulation ◽  
Risk Of Bleeding ◽  
Group 4 ◽  
High Bleeding Risk

Abstract ABSTRACT Background： Recommended regular saline flushing presents clinical ineffectiveness for hemodialysis (HD) patients at high risk of bleeding with heparin contraindication. Regional citrate anticoagulation (RCA) has previously been used with a Ca 2+ containing dialysate with prefiltered citrate in one arm (RCA-one). However, anticoagulation is not always achievable and up to 40% results in serious clotting in the venous expansion chamber. In this study, we have transferred one-quarter of the TSC from the prefiltered to the post filter based on RCA-one, which we have called RCA-two. The objective of this study was to compare the efficacy and safety of RCA-two with either saline flushing or RCA-one in HD patients with a high bleeding risk. Method ： In this investigator-initiated, multicenter, controlled, prospective, randomized clinical trial, 52 HD patients (77 sessions) were randomized to the RCA-two and RCA-one group in part one of the trial, and 45 patients (64 sessions) were randomized to the RCA-two and saline group in part two of the trial. Serious clotting events, adverse events and blood analyses were recorded. Results ：Serious clotting events in the RCA-two group were significantly lower compared with the RCA-one and saline group (7.89% vs. 30.77%, P = 0.011; 3.03% vs. 54.84%, P < 0.001, respectively). The median circuit survival time was 240 min (IQR 240 to 240) in the RCA-two group, was significantly longer than 230 min (IQR 155 to 240, P < 0.001) in the RCA-one group and 210 min (IQR 135 to 240，P = 0.003) in the saline group. The majority of the AEs were hypotension, hypoglycemia and chest tightness, most of which were mild in intensity. Eight patients (20.51%) in the RCA-one group, 4 patients (12.90%) in the saline group and 10 patients (26.31%) in the RCA-two group, P>0.05. Conclusions ： Our data demonstrated that the modified anticoagulation protocol was more effective and feasible during hemodialysis therapy for patients at high risk of bleeding. Trial registration: GDREC, GDREC2017250H. Registered February 2, 2018; prospectively registered.

scholarly journals Modified regional citrate anticoagulation is optimal for hemodialysis in patients at high risk of bleeding: A prospective randomized study of three anticoagulation strategies

2019 ◽  
Author(s):  
Ting Lin ◽  
Li Song ◽  
Renwei Huang ◽  
Ying Huang ◽  
Shuifu Tang ◽  
...  
Keyword(s):  
High Risk ◽  
Randomized Study ◽  
Bleeding Risk ◽  
Saline Group ◽  
Regional Citrate Anticoagulation ◽  
Expansion Chamber ◽  
Citrate Anticoagulation ◽  
Risk Of Bleeding ◽  
Group 4 ◽  
High Bleeding Risk

Abstract ABSTRACT Background： Recommended regular saline flushing presents clinical ineffectiveness for hemodialysis (HD) patients at high risk of bleeding with heparin contraindication. Regional citrate anticoagulation (RCA) has previously been used with a Ca 2+ containing dialysate with prefiltered citrate in one arm (RCA-one). However, anticoagulation is not always achievable and up to 40% results in serious clotting in the venous expansion chamber. In this study, we have transferred one-quarter of the TSC from the prefiltered to the post filter based on RCA-one, which we have called RCA-two. The objective of this study was to compare the efficacy and safety of RCA-two with either saline flushing or RCA-one in HD patients with a high bleeding risk. Method ： In this investigator-initiated, multicenter, controlled, prospective, randomized clinical trial, 52 HD patients (77 sessions) were randomized to the RCA-two and RCA-one group in part one of the trial, and 45 patients (64 sessions) were randomized to the RCA-two and saline group in part two of the trial. Serious clotting events, adverse events and blood analyses were recorded. Results ：Serious clotting events in the RCA-two group were significantly lower compared with the RCA-one and saline group (7.89% vs. 30.77%, P = 0.011; 3.03% vs. 54.84%, P < 0.001, respectively). The median circuit survival time was 240 min (IQR 240 to 240) in the RCA-two group, was significantly longer than 230 min (IQR 155 to 240, P < 0.001) in the RCA-one group and 210 min (IQR 135 to 240，P = 0.003) in the saline group. The majority of the AEs were hypotension, hypoglycemia and chest tightness, most of which were mild in intensity. Eight patients (20.51%) in the RCA-one group, 4 patients (12.90%) in the saline group and 10 patients (26.31%) in the RCA-two group, P>0.05. Conclusions ： Our data demonstrated that the modified anticoagulation protocol was more effective and feasible during hemodialysis therapy for patients at high risk of bleeding. Trial registration: GDREC, GDREC2017250H. Registered February 2, 2018; prospectively registered.

scholarly journals Modified regional citrate anticoagulation is optimal for hemodialysis in patients at high risk of bleeding: A prospective randomized study of three anticoagulation strategies

2019 ◽  
Author(s):  
Ting Lin ◽  
Li Song ◽  
Renwei Huang ◽  
Ying Huang ◽  
Shuifu Tang ◽  
...  
Keyword(s):  
Clinical Trial ◽  
High Risk ◽  
Randomized Study ◽  
Bleeding Risk ◽  
Saline Group ◽  
Regional Citrate Anticoagulation ◽  
Expansion Chamber ◽  
Citrate Anticoagulation ◽  
Risk Of Bleeding ◽  
High Bleeding Risk

Abstract Background：The recommended regular saline flushing presents clinical ineffectiveness for patients at high risk of bleeding with heparin contraindication. Regional citrate anticoagulation (RCA) has been used in a Ca2+ containing dialysate with prefilter citrate in one arm (RCA-one). The anticoagulation effect was not realized, and up to 40% resulted in serious clotting in the venous expansion chamber. We innovatively transferred one-quarter of the TSC from the prefilter to the postfilter based on RCA-one, which is called RCA-two in this trial. The objective of this study was to compare the efficacy and safety of RCA-two with either saline flushing or RCA-one in HD patients with a high bleeding risk. Method：In this investigator-initiated, multicenter, placebo-controlled, prospective, randomized clinical trial, 52 patients (77 sessions) were randomized to the RCA-two and RCA-one group in part one trial, and 45 patients (64 sessions) were randomized to the RCA-two and Saline group in part two trial. Serious clotting events, adverse events and blood analyses were recorded. Results：The primary outcome, Serious clotting events in the RCA-two group were significantly lower than that in the RCA-one and Saline group (7.89% vs. 30.77%, P = 0.011; 3.03% vs. 54.84%, P < 0.001, respectively). The median circuit survival time was 240 min (IQR 240 to 240) in the RCA-two group, which was significantly longer than 230 min (IQR 155 to 240, P < 0.001) in the RCA-one group and 210 min (IQR 135 to 240，P = 0.003) in the Saline group. The majority of the AEs were hypotension, hypoglycemia and chest tightness, most of which were mild in intensity. Eight patients (20.51%) in the RCA-one group, 4 patients (12.90%) in the Saline group and 10 patients (26.31%) in the RCA-two group, P>0.05. Conclusions：Our data demonstrated that the modified anticoagulation protocol is more effective and feasible during hemodialysis therapy for patients at high risk of bleeding. Trial registration: GDREC, GDREC2017250H. Registered 2th February 2018-Retrospectively registered. Keywords: regional citrate anticoagulation, hemodialysis, high risk of bleeding, serious clotting, saline flushing, randomized prospective clinical trial.

scholarly journals Current Concepts on Antiplatelet Therapy: Focus on the Novel Thienopyridine and Non-Thienopyridine Agents

2010 ◽  
Vol 2010 ◽  
pp. 1-7 ◽  
Author(s):  
L. Testa ◽  
G. G. L. Biondi Zoccai ◽  
M. Valgimigli ◽  
R. A. Latini ◽  
S. Pizzocri ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Clinical Practice ◽  
Drug Targeting ◽  
Bleeding Risk ◽  
Daily Practice ◽  
Adenosine Diphosphate ◽  
Bleeding Complications ◽  
The Novel ◽  
Platelet Activity ◽  
Risk Of Bleeding

Thienopyridines are a class of drug targeting the platelet adenosine diphosphate (ADP) 2 receptor. They significantly reduce platelet activity and are therefore clinically beneficial in settings where platelet activation is a key pathophysiological feature, particularly myocardial infarction. Ticlopidine, the first of the class introduced to clinical practice, was soon challenged and almost completely replaced by clopidogrel for its better tolerability. More recently, prasugrel and ticagrelor have been shown to provide a more powerful antiplatelet action compared to clopidogrel but at a cost of higher risk of bleeding complications. Cangrelor, a molecule very similar to ticagrelor, is currently being evaluated against clopidogrel. Considering the key balance of ischemic protection and bleeding risk, this paper discusses the background to the development of prasugrel, ticagrelor, and cangrelor and aims to characterise their risk-benefit profile and possible implementation in daily practice.

Regional Citrate Anticoagulation for High Volume Continuous Venovenous Hemodialysis in Surgical Patients With High Bleeding Risk

2012 ◽  
Vol 17 (2) ◽  
pp. 202-212 ◽  
Author(s):  
Robert Kalb ◽  
Rainer Kram ◽  
Stanislao Morgera ◽  
Torsten Slowinski ◽  
Detlef Kindgen-Milles
Keyword(s):  
High Volume ◽  
Bleeding Risk ◽  
Surgical Patients ◽  
Regional Citrate Anticoagulation ◽  
Citrate Anticoagulation ◽  
Continuous Venovenous Hemodialysis ◽  
High Bleeding Risk

scholarly journals Regional citrate-calcium anticoagulation during polymyxin-B hemoperfusion: A case series

2018 ◽  
Vol 41 (6) ◽  
pp. 319-324
Author(s):  
Francesco Forfori ◽  
Etrusca Brogi ◽  
Anna Sidoti ◽  
Martina Giraudini ◽  
Gianpaola Monti ◽  
...  
Keyword(s):  
High Risk ◽  
Surgical Complications ◽  
Case Series ◽  
Polymyxin B ◽  
Regional Citrate Anticoagulation ◽  
Metabolic Complications ◽  
Citrate Anticoagulation ◽  
Risk Of Bleeding ◽  
Published Report ◽  
Polymyxin B Hemoperfusion

Introduction: So far, only heparin-based anticoagulation has been proposed during polymyxin-B hemoperfusion. However, postsurgical septic patients can be at high risk of bleeding due to either surgical complications or septic coagulation derangement. Consequently, heparin should not represent in some cases the anticoagulation regimen of choice in this type of patients. Methods and results: We present a case series of four postsurgical septic patients treated with polymyxin-B hemoperfusion using regional citrate anticoagulation. All the treatments were performed without complications. During each treatment, there were no episodes of filter clotting, no bleeding, and no metabolic complications for any of the patients. Conclusion: To our knowledge, this is the second published report on the use of citrate anticoagulation during polymyxin-B hemoperfusion. Our case series continued to show that regional citrate anticoagulation regimen is feasible and safe during polymyxin-B hemoperfusion treatment in postsurgical septic patients.

scholarly journals Regional Citrate Anticoagulation versus No-Anticoagulation for Continuous Venovenous Hemofiltration in Acute Severe Hypernatremia Patients with Increased Bleeding Risk: A Retrospective Cohort Study

2019 ◽  
Vol 49 (1-2) ◽  
pp. 44-54
Author(s):  
Lijuan Zhao ◽  
Feng Ma ◽  
Yan Yu ◽  
Yangping Li ◽  
Yan Wang ◽  
...  
Keyword(s):  
Reduction Rate ◽  
Bleeding Risk ◽  
Regional Citrate Anticoagulation ◽  
Continuous Venovenous Hemofiltration ◽  
Sodium Reduction ◽  
Citrate Anticoagulation ◽  
Assessment Scores ◽  
Failure Assessment ◽  
Randomized Control ◽  
High Bleeding Risk

Purpose: This study was aimed at evaluating the efficacy and safety of regional citrate anticoagulation (RCA) versus no-anticoagulation continuous venovenous hemofiltration (CVVH) in acute severe hypernatremia patients with increased bleeding risk. Materials and Methods: Acute severe hypernatremia patients with high bleeding risk who underwent CVVH in our center between January 2011 and October 2017 were considered as candidates. Patients who were <18 years old, with hypovolemic hypernatremia, and had systemic anticoagulation were excluded. The included patients were divided into RCA and no-anticoagulation groups according to their anticoagulation strategy during CVVH and matched by age, sequential organ failure assessment scores, and vasopressor dependency. Results: Of the 64 included patients, no-anticoagulation and RCA were employed for CVVH in 23 and 41 patients, respectively. The serum sodium reduction rate (RRSeNa) was not significantly different between the no-anticoagulation and RCA groups (p = 0.729). Compared to no-anticoagulation, RCA significantly prolonged the circuit survival time (15 h [4.1–23.9] vs. 51 h [21.3–80.7], p = 0.001). The incidence of filter failure was 65.2% (15/23) in the no-anticoagulation group and 2.4% (1/41) in the RCA group (p < 0.001), respectively. In the matched cohort, the RRSeNas were not different between the 2 groups (p = 0.569), and the filter lifespan was significantly longer in the RCA group as well (p < 0.001). Conclusion: RCA might be safe and effective for acute severe hypernatremia patients who underwent CVVH treatment. Further prospective, randomized, control trials are warranted to obtain robust evidences.

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