Clinical review: anticoagulation for continuous renal replacement therapy--heparin or citrate?

摘要: Heparin is the most commonly prescribed anticoagulant for continuous renal replacement therapy. There is, however, increasing evidence questioning its safety, particularly in critically ill. mainly confers effect by binding to antithrombin. binds numerous other proteins and cells as well, compromising efficacy safety. Owing antithrombin consumption degradation, of heparin acute phase proteins, apoptotic necrotic cells, critical illness resistance. The nonspecific further leads an unpredictable interference with inflammation pathways, microcirculation phagocytotic clearance dead possible deleterious consequences patients sepsis systemic inflammation. Regional anticoagulation citrate does not increase patient's risk bleeding. benefits include a longer or similar circuit life, possibly better patient kidney survival. This needs be confirmed larger randomized controlled multicenter trials. use might associated less has useful bio-energetic implications. Citrate can, inadequate cause metabolic derangements. Full advantages can only realized if risks are well controlled. These observations suggest greater role citrate.