Department of Anesthesia and Perioperative Care, Division of Critical Care Medicine, UCSF School of Medicine, San Francisco, CA, USA.
INI-CRCT Network, Nancy, France.
Semin Dial. 2021 Nov;34(6):416-422. doi: 10.1111/sdi.12959. Epub 2021 Mar 8.
The most common anticoagulant options for continuous renal replacement therapy (CRRT) include unfractionated heparin (UFH), regional citrate anticoagulation (RCA), and no anticoagulation. Less common anticoagulation options include UFH with protamine reversal, low-molecular weight heparin (LMWH), thrombin antagonists, and platelet inhibiting agents. The choice of anticoagulant for CRRT should be determined by patient characteristics, local expertise, and ease of monitoring. The Kidney Disease Improving Global Outcomes (KDIGO) acute kidney injury guidelines recommend using RCA rather than UFH in patients who do not have contraindications to citrate and are with or without increased risk of bleeding. Monitoring should include evaluation of the anticoagulant effect, circuit life, filter efficacy, and complications.
连续性肾脏替代治疗（CRRT）最常用的抗凝选择包括未分馏肝素（UFH）、局部枸橼酸抗凝（RCA）和无抗凝。不太常用的抗凝选择包括用鱼精蛋白逆转的 UFH、低分子量肝素（LMWH）、凝血酶拮抗剂和血小板抑制剂。CRRT 抗凝剂的选择应根据患者特点、当地专业知识和监测的便利性来确定。肾脏病：改善全球预后组织（KDIGO）急性肾损伤指南建议在没有枸橼酸盐禁忌且无论是否有增加出血风险的患者中，使用 RCA 而不是 UFH。监测应包括抗凝效果、回路寿命、滤器效率和并发症的评估。
