ACD-A solution as anticoagulant in continuous blood purification for patients at high risk of bleeding / 中华肾脏病杂志

ABSTRACT

Objective To evaluate the effect and safety of anticoagulant citrate dextrose solution A (ACD-A ) in continuous blood purification (CBP) for patients at high risk of bleeding with ARF. Methods Twelve patients at high risk of bleeding, treated with continuous venovenous hemofiltration(CVVH), were divided into regional citrate anticoagulant (RCA) group and control group. In the former, ACD-A solution was delivered, pre-filter , with the rate adjusted to maintain a postfilter ionized calcium (iCa2+) level between 0.30-0.40 mmol/L. Before the extracorporeal blood returned to the patient, 10% calcium gluconate was infused to maintain a systemic iCa2+ level between 0.90-1.20 mmol/L. In control group, CVVH were performed either with low dose of heparin LMW sodium (1700-2500 IU/12 h-24 h)or without anticoagulant. The life span of each hemofilter was recorded. In RCA group, prothrombin time (PT), activated partial thromboplastin time (APTT) , acid-base changes, serum sodium and iCa2+ were monitored pre- and during CVVH. Result In the whole duration 1192.5 hours of CVVH in RCA group and 596 hours in control group, 62 and 42 hemofilters were used, respectively. Filter survival was 65.3% at 24 h and 24.5% at 48 h in RCA group,while 14.5% and 0 in control group. The mean life span of filter in RCA group was significantly longer than that in control group[(29.4?21.0) (1.5-71.5)h vs( 14.2?8.2) (4.5-40)h, P