Transcript Observational Study: Utilisation of citrate vs heparin

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Observational Study: Utilisation of Citrate Versus Heparin Anticoagulation
for Continuous Renal Replacement Therapy in Intensive Care Unit May
Reduce Patients Need for Blood Transfusion
Joyce RY Chew, Victor Nwokocha, Andre Khoo, Andrew Mizen, Pejman Davoudian
Department of Critical Care Medicine, West Suffolk Hospital, Bury St Edmunds, United Kingdom
Objective
Results
Mean Units of Packed
Red Cells Transfused
Units
As one of the first intensive care units within East
of England to use citrate in place of heparin, we
have conducted this study to compare the
transfusion frequency and volume associated with
using these agents.
Methodology
We carried out a retrospective observational study
to compare outcomes related to the use of heparin
and citrate treatment protocols. The study
population comprised the last 40 consecutive
patients with acute kidney injury requiring CRRT
for more than 24 hours who received heparin or
citrate.
2
1.8
1.6
1.4
1.2
1
0.8
0.6
0.4
0.2
0
25
72
24.5
70
24
68
Years
APACHE Score
23.5
23
66
64
22.5
62
22
60
21.5
58
Citrate
Heparin
Citrate
Mean Haemoglobin
Levels
10.4
10.2
10
9.8
9.6
9.4
9.2
9
Citrate
Heparin
Heparin
Length of Treatment
Days
Citrate is an anticoagulant agent that has shown
promise with favourable efficacy and safety
profiles for use during continuous renal
replacement therapy (CRRT). These benefits have
1
been well reported in the literature . However,
there has only been very limited number of studies
comparing citrate to heparin, which is more
commonly used in CRRT.
Mean Patient Age
Mean APACHE Score
g/dL
Background
We excluded patients with active bleeding, preexisting coagulopathy, previously known end stage
renal failure and all surgical patients in our study.
The ICU electronic records system (Metavision)
was reviewed for patient demographics, cause of
acute kidney injury, mean haemoglobin levels,
transfusion frequency, transfusion volume and final
outcome. Collected data was analysed using the
standard t-test to determine significant differences
in demographics, volume and frequency of
transfusion and mean Hb. Fisher’s exact test was
used to analyse the final outcome data.
5
4.5
4
3.5
3
2.5
2
1.5
1
0.5
0
Citrate
Heparin
• There was no significant difference in the mean
APACHE score, age, mean haemoglobin level,
length of treatment and mortality rate between
treatment groups.
Conclusion
Citrate
Heparin
• Significantly less units of packed red cells were
transfused in the citrate treatment arm compared
to the heparin arm (p=0.006). Furthermore, only
22.5% of patients in the citrate arm required
transfusion, compared to 53.5% in the heparin
arm.
This study shows that citrate as a regional
anticoagulant agent demonstrated benefits over
heparin in CRRT with respect to the need for
transfusion and the total number of units
transfused.
References:
1. Gerd R Hetzel, Michael Schmitz, Heimo Wissing et al. Regional citrate versus
systemic heparin for anticoagulation in critically ill patients on continuous
venovenous haemofiltration: a prospective randomized multicentre trial. Nephrol
Dial Transplant (2011) 26: 232–239