Regional citrate anticoagulation using a citrate-based substitution solution for continuous venovenous hemofiltration in cardiac surgery patients.
OBJECTIVE
To evaluate the feasibility, efficacy, safety and side effects of routinely performed continuous venovenous hemofiltration (CVVH) with regional citrate anticoagulation using a citrate-containing substitution solution as compared with conventional systemic low-dose unfractionated heparin-anticoagulation in postoperative cardiac surgery patients.


METHODS
Database review of all patients on CVVH during a three-year period at a cardiovascular intensive care unit of a tertiary referring university hospital.


METHODS
Patients who had undergone cardiac surgery with acute or chronic renal failure were studied. Thirty-seven citrate CVVH courses in 31 patients (January to November 2000) and 59 heparin CVVH courses in 50 patients (1998 and 1999) had been undertaken postoperatively. Indications for hemofiltration were acute renal failure in 24 and chronic renal failure in 7 of the citrate patients, and acute renal failure in 44 and chronic renal failure in 6 of the heparin patients.


METHODS
CVVH with either regional citrate anticoagulation using a custom-made citrate-based substitution solution or unfractionated heparin anticoagulation.


METHODS
The following parameters were measured: median filtration time, hemofilters used per day, differences in creatinine and blood urea levels as opposed to baseline, blood loss within the first 24 h of hemofiltration, incidence of bleeding-related resternotomies, acidosis, and alkalosis.


RESULTS
No significant differences in any of the measured parameters were registered. No serious electrolyte imbalance was observed in either group. Furthermore, the two groups did not differ in terms of mortality, duration of stay in the intensive care unit or in hospital, and restoration rate of normal renal function.


CONCLUSIONS
We conclude that citrate-based regional anticoagulation is effective, safe and easy to use in CVVH following cardiac surgery and might become the first choice for anticoagulation in patients in whom the application of systemic heparin is contraindicated.
Thoenen
Michèle
M
Division of Cardiovascular Anaesthesia, Institute of Anaesthesiology, University Hospital, Zurich, Switzerland.
Schmid
Edith R
ER
Binswanger
Ulrich
U
Schuepbach
Rolf
R
Aerne
Daniel
D
Schmidlin
Daniel
D
D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D019343:Citric Acid / Q000009:adverse effects / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D005240:Feasibility Studies; D005260:Female; D006331:Heart Diseases / Q000601:surgery*; D006440:Hemofiltration; D006493:Heparin / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000628:therapy*; D051437:Renal Insufficiency / Q000628:therapy*; D012189:Retrospective Studies
D000925:Anticoagulants; D019343:Citric Acid; D006493:Heparin