Effect of sodium citrate anticoagulant solution in continuous veno-venous hemofiltration in critically ill children.

BACKGROUND

Anticoagulants commonly used in the continuous veno-venous hemofiltration (CVVH) include unfractionated heparin, low-molecular-weight heparin, and sodium citrate. This study investigated the clinical anticoagulation effects of sodium citrate, low-molecular-weight heparin and non-heparin anticoagulants in critically ill children during CVVH.

METHODS

This was a retrospective study based on the medical records of 86 critically ill children who were admitted to the Pediatric Intensive Care Unit of our hospital and received the CVVH treatment during January 2021 to May 2023. According to coagulation test results and choice of anticoagulant, 28 cases who received normal results in the coagulation tests and treated with low-molecular-weight heparin were classified into Group a1; 36 cases who received normal results in the coagulation tests and treated with 4% sodium citrate were classified into Group a2; 8 cases who received abnormal results in the coagulation tests and treated with a non-heparin anticoagulant were classified into Group b1; and 14 cases who received abnormal results in the coagulation tests and treated with 4% sodium citrate were classified into Group b2.

RESULTS

No statistically significant differences were identified in the results of blood gas and electrolyte tests before and after treatment (P > 0.05). The levels of creatinine, blood urea nitrogen and lactic acid after treatment were significantly lower than those before. No statistically significant differences were identified in activated partial thromboplastin time in Group a1 and Group a2 before and after treatment. The values of prothrombin time and platelet count in Group a2 were higher than Group a1 after treatment (P < 0.05). The incidences of treatment interruption caused by coagulation in groups a2 and b2 were lower than groups a1 and b1, respectively. Better performance was found in extending treatment duration, reducing coagulation in lines and filters and reducing the risk of bleeding in Group a2 compared with a1 (P < 0.05). No statistically significant differences were identified in the incidences of hypernatrium, hypocalcemia and acidosis/alkalosis (P > 0.05).

CONCLUSION

Sodium citrate is safer and more effective in anticoagulation during CVVH compared with low-molecular-weight heparin and non-heparin anticoagulants.

CLINICAL TRIAL NUMBER

Not applicable.