局部枸橼酸盐抗凝对急性肾损伤接受连续性肾脏替代治疗的危重症患者凝血酶生成、纤维蛋白溶解及血小板功能的影响：一项前瞻性研究。

Effects of regional citrate anticoagulation on thrombin generation, fibrinolysis and platelet function in critically ill patients receiving continuous renal replacement therapy for acute kidney injury: a prospective study.

作者信息

Fisher Richard, Moore Gary W, Mitchell Michael J, Dai Letian, Crichton Siobhan, Lumlertgul Nuttha, Ostermann Marlies

机构信息

Department of Critical Care, King's College Hospital, London, UK.

Department of Haemostasis and Thrombosis, Viapath Analytics LLP, Guy's & St Thomas' NHS Foundation Trust, London, UK.

出版信息

Ann Intensive Care. 2022 Mar 31;12(1):29. doi: 10.1186/s13613-022-01004-w.

DOI:10.1186/s13613-022-01004-w

PMID:35355147

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8967919/

Abstract

BACKGROUND

Regional citrate anticoagulation (RCA) is recommended for continuous renal replacement therapy (CRRT). However, filter life varies and premature filter clotting can occur. The aims of this explorative prospective study were to investigate the effects of RCA on thrombin generation, fibrinolysis and platelet function in critically ill patients receiving CRRT, to compare clotting parameters between systemic and intra-circuit blood samples, and to screen participants for coagulation disorders. We recruited critically ill adult patients admitted to a 30-bedded Intensive care unit in a tertiary care hospital who required CRRT with RCA for acute kidney injury (AKI). Patients with pre-existing thrombotic, bleeding tendencies or a CRRT duration less than 48 h were excluded. We measured coagulation and thrombophilia parameters at baseline. Thrombin generation, D-dimer and platelet function were measured pre-CRRT and at 12, 24, 36, 48 and 72 h after commencing CRRT using blood samples taken from the arterial line and the circuit.

RESULTS

At baseline, all eleven patients (mean age 62.4 years, 82% male) had Factor VIII and von Willebrand Factor concentrations above reference range and significantly increased peak thrombin generation. During CRRT, there were no significant changes in systemic maximum peak thrombin generation, time to peak thrombin generation, fibrinogen, D-dimer and platelet function analysis. We observed no significant difference between paired samples taken from the patient's arterial line and the circuit.

CONCLUSIONS

Critically ill patients with AKI requiring CRRT are hypercoagulable. Citrate used for anticoagulation during CRRT does not affect thrombin generation, D-dimer or platelet function. Systemic clotting parameters reflect intra-circuit results.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT02486614. Registered 01 July 2015-Registered after recruitment of first patient. https://clinicaltrials.gov/ct2/show/NCT02486614.

摘要

背景

对于连续性肾脏替代治疗（CRRT），推荐采用局部枸橼酸盐抗凝（RCA）。然而，滤器寿命各不相同，且可能会过早出现滤器凝血。这项探索性前瞻性研究的目的是调查RCA对接受CRRT的危重症患者凝血酶生成、纤维蛋白溶解和血小板功能的影响，比较全身血样和体外循环血样的凝血参数，并筛查参与者是否存在凝血障碍。我们招募了入住一家拥有30张床位的三级医院重症监护病房、因急性肾损伤（AKI）需要接受RCA治疗的CRRT危重症成年患者。排除既往有血栓形成、出血倾向或CRRT持续时间少于48小时的患者。我们在基线时测量了凝血和血栓形成倾向参数。在开始CRRT前以及开始CRRT后12、24、36、48和72小时，使用从动脉管路和体外循环中采集的血样测量凝血酶生成、D-二聚体和血小板功能。

结果

在基线时，所有11名患者（平均年龄62.4岁，82%为男性）的凝血因子VIII和血管性血友病因子浓度均高于参考范围，凝血酶生成峰值显著增加。在CRRT期间，全身最大凝血酶生成峰值、达到凝血酶生成峰值的时间、纤维蛋白原、D-二聚体和血小板功能分析均无显著变化。我们观察到从患者动脉管路和体外循环中采集的配对血样之间无显著差异。