Deep Akash, Zoha Mohammad, Dutta Kukreja Pompa
Paediatric Intensive Care Unit, King's College Hospital, Denmark Hill, London, UK.
Blood Purif. 2017;43(4):279-289. doi: 10.1159/000452754. Epub 2017 Jan 25.
Effective delivery of continuous renal replacement therapy (CRRT) depends on the longevity of the filter and circuit used in the CRRT machine. Safe and effective anticoagulation is crucial for maintaining the patency of these circuits. In children, heparin and citrate are the commonly used anticoagulants but they are limited by serious side effects and thus calls for meticulous monitoring. In conditions where neither of these can be used, prostacyclin can be an effective alternative. Prostacyclin is a platelet inhibitor that can be safely used as an efficient anticoagulant in CRRT. When combined with heparin, it induces a heparin-sparing effect, which can reduce the dosage and side effects of heparin. Furthermore, there is no need for performing time-consuming monitoring tests. Although prostacyclin seems to be an attractive option, there is scanty evidence about its use as an anticoagulant in CRRT in children. We review the evidence and practicalities, and propose a guideline for the use of prostacyclin as an anticoagulant in children requiring CRRT.
持续肾脏替代治疗（CRRT）的有效实施取决于CRRT机器中使用的滤器和管路的使用寿命。安全有效的抗凝对于维持这些管路的通畅至关重要。在儿童中，肝素和枸橼酸盐是常用的抗凝剂，但它们受到严重副作用的限制，因此需要进行细致的监测。在无法使用这两种抗凝剂的情况下，前列环素可以是一种有效的替代方案。前列环素是一种血小板抑制剂，可在CRRT中安全地用作高效抗凝剂。与肝素联合使用时，它会产生肝素节省效应，可减少肝素的剂量和副作用。此外，无需进行耗时的监测测试。尽管前列环素似乎是一个有吸引力的选择，但关于其在儿童CRRT中用作抗凝剂的证据却很少。我们回顾了相关证据和实际情况，并提出了在需要CRRT的儿童中使用前列环素作为抗凝剂的指南。
