Pharmacological interventions for preventing clotting of extracorporeal circuits during continuous renal replacement therapy

Tsujimoto, Hiraku; Tsujimoto, Yasushi; Nakata, Yukihiko; Fujii, Tomoko; Takahashi, Sei; Akazawa, Mai; Kataoka, Yuki

doi:10.1002/14651858.cd012467.pub2

Cited by 15 publications

(15 citation statements)

References 77 publications

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“…Compared with heparin, high-quality evidence demonstrated that regional citrate had a bleeding rate less than 5% in critically ill patients and had a low risk of circuit loss, filter failure and heparininduced thrombocytopenia. [26][27][28][29] Therefore, it was considered a satisfactory anticoagulant. With the developments of anticoagulants in CRRT, our regression analysis excluded the CRRT as a risk factor for bleeding in critically ill patients with pneumonia.…”

Section: Discussionmentioning

confidence: 99%

Hemorrhage and venous thromboembolism in critically ill patients with COVID-19

Qiu

Wei

et al. 2021

SAGE Open Medicine

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Objective: The majority of patients with COVID-19 showed mild symptoms. However, approximately 5% of them were critically ill and require intensive care unit admission for advanced life supports. Patients in the intensive care unit were high risk for venous thromboembolism and hemorrhage due to the immobility and anticoagulants used during advanced life supports. The aim of the study was to report the incidence and treatments of the two complications in such patients. Method: Patients with COVID-19 (Group 1) and patients with community-acquired pneumonia (Group 2) that required intensive care unit admission were enrolled in this retrospective study. Their demographics, laboratory results, ultrasound findings and complications such as venous thromboembolism and hemorrhage were collected and compared. Results: Thirty-four patients with COVID-19 and 51 patients with community-acquired pneumonia were included. The mean ages were 66 and 63 years in Groups 1 and 2, respectively. Venous thromboembolism was detected in 6 (18%) patients with COVID-19 and 18 (35%) patients with community-acquired pneumonia (P = 0.09). The major type was distal deep venous thrombosis. Twenty-one bleeding events occurred in 12 (35%) patients with COVID-19 and 5 bleeding events occurred in 5 (10%) patients with community-acquired pneumonia, respectively (P = 0.01). Gastrointestinal system was the most common source of bleeding. With the exception of one death due to intracranial bleeding, blood transfusion with or without surgical/endoscopic treatments was able to manage the bleeding in the remaining patients. Multivariable logistic regression showed increasing odds of hemorrhage with extracorporeal membrane oxygenation (odds ratio: 13.9, 95% confidence interval: 4.0–48.1) and COVID-19 (odds ratio: 4.7, 95% confidence interval: 1.2–17.9). Conclusion: Venous thromboembolism and hemorrhage were common in both groups. The predominant type of venous thromboembolism was distal deep venous thrombosis, which presented a low risk of progression. COVID-19 and extracorporeal membrane oxygenation were risk factors for hemorrhage. Blood transfusion with or without surgical/endoscopic treatments was able to manage it in most cases.

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Section: Discussionmentioning

confidence: 99%

Hemorrhage and venous thromboembolism in critically ill patients with COVID-19

Qiu

Wei

et al. 2021

SAGE Open Medicine

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“…Even after propensity score matching, the present study comprised a larger number of patients (268) who received NM for blood purification than the above-mentioned systematic review by Kang et al that included not only RCT but also non-RCT patients (252). Although observing significant reductions of mortality in studies examining anticoagulants for blood purification is difficult [ 27 ], the relatively large sample size of this dataset enabled us to evaluate the significance of NM administration on survival outcomes. Further, we recently reported that the dataset used in the present study includes a significant positive effect modification on survival outcomes of sepsis between thrombomodulin-alpha and PMX-HP treatment [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

Nafamostat Mesylate Improved Survival Outcomes of Sepsis Patients Who Underwent Blood Purification: A Nationwide Registry Study in Japan

Kamijo

Mochizuki

Nakamura

et al. 2020

JCM

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Nafamostat mesylate (NM) is a synthetic serine protease inhibitor that can be used as an anticoagulant during blood purification in critically ill patients, as well as a treatment for disseminated intravascular coagulation. Although NM has been reported to reduce the risk of bleeding during blood purification, its effect on survival outcomes of patients who received blood purification treatments is unclear. We hypothesized that administration of NM during blood purification can reduce mortality in patients with sepsis. A post hoc analysis was conducted on a nationwide retrospective registry that included data from 3195 sepsis patients registered at 42 intensive care units throughout Japan. We evaluated the effect of NM on hospital mortality and bleeding complications using propensity score matching in 1216 sepsis patients who underwent blood purification in the intensive care unit (ICU). Two-hundred-and-sixty-eight pairs of propensity score-matched patients who received NM and conventional therapy were compared. Hospital and ICU mortality rates in the NM group were significantly lower than those in the conventional therapy group. However, rates of bleeding complications did not differ significantly between the two groups. These data suggest that administration of NM improved the survival outcomes of sepsis patients who underwent blood purification in the ICU.

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“…Second, an effective treatment time of 20 hours per day was recommended [41], and it could be achieved by using only 1 circuit with a lifespan of ≥ 24 hours, leaving 1-3 hours downtime per day [42]. In addition, most of the centers and studies de ned successful prevention of clotting as no need for circuit change in the rst 24 hours [43].…”

Section: Risk Factors Of Lter Failurementioning

confidence: 99%

A Prediction Model of Sufficient Filter Lifespan in Anticoagulation-free CRRT Patients

Zhang¹,

Bai²,

Zhang³

et al. 2020

Preprint

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Background: Anticoagulation-free continuous renal replacement therapy (CRRT) was recommended by the current clinical guideline for patients with increased bleeding risk and contraindications of citrate and resulted in heterogeneous filter lifespan. There was no prediction model to identify the patients would have sufficient filter lifespan when they have to accept CRRT without the use of any anticoagulation. The purpose of our present study is to develop a clinical prediction model of sufficient filter lifespan in anticoagulation-free CRRT patients.Method: Patients who underwent anticoagulation-free CRRT in our center between June 2013 and June 2019 were retrospectively included. The primary outcome was sufficient filter lifespan (≥ 24 hours). The final model was established by using multivariable logistic regression analysis. And, the prediction model was validated in an external cohort. Results: A total of 170 patients were included in the development cohort. Sufficient filter lifespan were observed in 80 patients. The probability of sufficient filter lifespan could be calculated using the following regression formula: P (%) = exp (Z)/1 + exp (Z), where Z = 0.49896-(0.08552*BMI)+(0.44107*T)+(0.03373*MAP)-(0.03389*WBC)+(1.51579*[vasopressor=1])-(0.01132*PLT)+(0.00422*ALP)-(2.66910*pH)-(0.00214*UA)+(0.05992*BUN)+(0.00400*Db)–(0.00014*D-dimer)+(0.02818*APTT). The area under the curve (AUC) of the stepwise model and internal validation model was 0.82 (95%CI [0.76-0.88]) and 0.8 (95%CI [0.74-0.87]), respectively. At the optimal cut-off value of -0.1052, the positive predictive value and the negative predictive value of the stepwise model was 0.77 and 0.79, respectively. The AUC of the external model was 0.82 (95%CI [0.69-0.96]). Conclusion: The use of a prediction model instead of an assessment based only on coagulation parameters could facilitate the identification of the patients with filter lifespan of ≥ 24 hours when they accepted anticoagulation-free CRRT.

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Pharmacological interventions for preventing clotting of extracorporeal circuits during continuous renal replacement therapy

Cited by 15 publications

References 77 publications

Hemorrhage and venous thromboembolism in critically ill patients with COVID-19

Hemorrhage and venous thromboembolism in critically ill patients with COVID-19

Nafamostat Mesylate Improved Survival Outcomes of Sepsis Patients Who Underwent Blood Purification: A Nationwide Registry Study in Japan

A Prediction Model of Sufficient Filter Lifespan in Anticoagulation-free CRRT Patients

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Pharmacological interventions for preventing clotting of extracorporeal circuits during continuous renal replacement therapy

Cited by 15 publications

References 77 publications

Hemorrhage and venous thromboembolism in critically ill patients with COVID-19

Hemorrhage and venous thromboembolism in critically ill patients with COVID-19

Nafamostat Mesylate Improved Survival Outcomes of Sepsis Patients Who Underwent Blood Purification: A Nationwide Registry Study in Japan

A Prediction Model of Sufficient Filter Lifespan in Anticoagulation-free CRRT&nbsp;Patients

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A Prediction Model of Sufficient Filter Lifespan in Anticoagulation-free CRRT Patients