Comparison of efficacy and prognosis between citrate and low molecular weight heparin in tumor patients undergoing continuous renal replacement therapy

doi:10.3877/cma.j.issn.2096-1537.2017.03.009

Abstract

Abstract:

Objective

To compare the effect of citrate on anticoagulation efficacy and outcome with low molecular weight heparin during continuous renal replacement treatment (CRRT) in cancer patients.

Methods

Retrospectively analyze the clinical data of 117 patients admitted in intensive care unit (ICU) of Sun Yat-sen University Cancer Center and received CRRT from September 2012 to October 2016. Among all patients, 18 patients received citrate (TCG group), while other 99 patients received low molecular heparin treatment (THG group). Rank-sum test was used to compare prothrombin time (PT), active partial thromboplastin time (APTT), blood platelet (PLT) count before CRRT. In addition, the change of PT, APTT, PLT, hemoglobin concentration during the first three days after CRRT, the stay of ICU and hospital and the filter life were also analyzed.

Results

In three days after CRRT, APTT in THG group was significant longer than patients in TCG group and there was a significant difference of APTT change between two groups [9.11(3.90, 9.11) s vs -0.94(-3.40, 3.38) s, Z=-4.001, P<0.001]. The filter life in TCG group was significant longer than that in THG group [29.64(19.47, 38.94) h vs 17.00(9.50, 24.40) h, Z=3.468, P=0.001]. However, there was no significant difference of PT, PLT, hemoglobin concentration change in 3 days after CRRT between two groups. What′s more, there was no difference of incidence of bleeding, length of ICU and hospital stay, and mortality, either.

Conclusion

In cancer patients, citrate had a better anticoagulation efficacy than low molecular weight heparinduring CRRT.

Key words: Continuous renal replacement treatment, Citrate, Low molecular weight heparin, Anticoagulation, Prognosis

Haoxian Ke, Xuantao Shen, Wenhui Yu, Zihao Li, Wen Yang, Yuyao Ji, Chongxiang Chen, Qingyu Zhao. Comparison of efficacy and prognosis between citrate and low molecular weight heparin in tumor patients undergoing continuous renal replacement therapy[J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2017, 03(03): 197-201.

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URL: https://icu.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2096-1537.2017.03.009

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References 19

1	Prandoni P, Falanga A, Piccioli A. Cancer and venous thromboembolism[J]. Lancet Oncol, 2005, 6(6): 401-410.
2	Lee AY, Levine MN. Venous thromboembolism and cancer: Risks and outcomes[J]. Circulation, 2003, 107(23 Suppl 1): Ⅰ17-Ⅰ21.
3	Herzog CA, Asinger RW, Berger AK, et al. Cardiovascular disease in chronic kidney disease. A clinical update from Kidney Disease: ImprovingGlobal Outcomes (KDIGO)[J]. Kid Int, 2011, 80 (6): 572-586.
4	Webb AR, Mythen MG, Jacobsen D, et al. Maintaining blood flow in the extracorporeal circuit: haemostasis and anti- coagulation[J]. Intensive Care Med, 1995, 21(1): 84-83.
5	Palsson R, Niles JL. Regional citrate anticoagulation in continuous venovenous hemofiltration in critically ill patients with a high risk of bleeding[J]. Kidney Int, 1999, 55(5): 1991-1997.
6	Mehta RL, McDonald BR, Aguilar MM, et al. Regional citrate anticoagulation for continuous arteriovenous hemodialysis in critically ill patients[J]. Kidney Int, 1990, 38(5): 976-981.
7	Liu C, Mao Z, Kang H, et al. Regional citrate versus heparin anticoagulation for continuous renal replacement therapy in critically ill patients: a meta-analysis with trial sequential analysis of randomized controlled trials[J]. Crit Care, 2016, 20(1): 144.
8	Santiago MJ, López-Herce J, Urbano J, et al. Complications of continuous renal replacement therapy in critically ill children: a prospective observational evaluation study[J]. Crit Care, 2009, 13(6): R184.
9	Liao YJ, Zhang L, Zeng XX, et al. Citrate versus unfractionated heparin for anticoagulation in continuous renal replacement therapy[J]. Chin Med J (Engl), 2013, 126(7): 1344-1349.
10	Tas F, Kilic L, Duranyildiz D. Coagulation tests show significant differences in patients with breast cancer[J]. Tumour Biol, 2014, 35(6): 5985-5992.
11	Khorana AA. The NCCN Clinical Practice Guidelines on Venous Thromboembolic Disease: strategies for improving VTE prophylaxis in hospitalized cancer patients[J]. Oncologist, 2007, 12 (11): 1361-1370.
12	Bai M, Zhou M, He L, et al. Citrate versus heparin anticoagulation for continuous renal replacement therapy: an updated meta-analysis of RCTs[J]. Intensive Care Med, 2015, 41(12): 2098-2110.
13	Zhang Z, Hongying N. Efficacy and safety of regional citrate anticoagulation in critically ill patients undergoing continuous renal replacement therapy[J]. Intensive Care Med, 2012, 38(1): 20-28.
14	Oudemans-van Straaten HM, Ostermann M. Bench-to-bedside review: Citrate for continuous renal replacement therapy, from science to practice[J]. Crit Care, 2014, 18(4): 249.
15	Morgera S, Scholle C, Voss G, et al. Metabolic complications during regional citrate anticoagulation in continuous venovenous hemodialysis: single-center experience[J]. Nephron Clin Pract, 2004, 97(4): c131-c136.
16	Su K, Chen F, Yan WM, et al. Fibrinogen-like protein 2/fibroleukinprothrombinase contributes to tumor hypercoagulability via IL-2 and IFN-gamma[J]. World J Gastroenterol, 2008, 14(39): 5980-5989.
17	Venkataraman R, Kellum JA. Defining acute renal failure: the RIFLE criteria[J]. J Intensive Care Med, 2007, 22(4): 187-193.
18	Stucker F, Ponte B, Tataw J, et al. Efficacy and safety of citrate-based anticoagulation compared to heparin in patients with acute kidney injury requiring continuous renal replacement therapy: a randomized controlled trial[J]. Crit Care, 2015, 19: 91.
19	Gutierrez-Bernays D, Ostwald M, Anstey C, et al. Transition From Heparin to Citrate Anticoagulation for Continuous Renal Replacement Therapy: Safety, Efficiency, and Cost[J]. Ther Apher Dial, 2016, 20(1): 53-59.

指标		枸橼酸抗凝组（n=18）	低分子肝素抗凝组（n=99）	统计值	P值
年龄（岁，±s）		61.6±17.0	60.1±14.3	t=0.209	0.835
性别（例，男性/女性）		17/1	71/28	χ²=3.089	0.079
吸烟史[例（%）]				χ²=2.935	0.087
	是	11（61.1）	39（39.4）
	否	7（38.9）	60（60.6）
饮酒史[例（%）]				χ²=1.733	0.188
	是	7（38.9）	21（21.2）
	否	11（61.1）	78（78.8）
既往史[例（%）]		12（66.7）	59（59.6）	χ²=0.319	0.572
	肾源性	4（22.2）	14（14.1）	χ²=0.269	0.604
	其他	8（44.4）	45（45.5）	χ²=0.006	0.937
	无	6（33.3）	40（40.4）
家族史[例（%）]				χ²=0.022	0.883
	是	3（16.7）	12（12.1）
	否	15（83.3）	87（87.9）
是否曾手术[例（%）]				χ²=24.547	<0.001
	是	12（66.7）	12（12.1）
	否	6（33.3）	87（87.9）
是否曾放疗[例（%）]				χ²=0.000	0.989
	是	2（11.1）	11（11.1）
	否	16（88.9）	88（88.9）
是否曾化疗[例（%）]				χ²=0.624	0.430
	是	10（55.6）	45（45.5）
	否	8（44.4）	54（54.5）

指标		枸橼酸抗凝组（n=18）	低分子肝素抗凝组（n=99）	统计值	P值
年龄（岁，±s）		61.6±17.0	60.1±14.3	t=0.209	0.835
性别（例，男性/女性）		17/1	71/28	χ²=3.089	0.079
吸烟史[例（%）]				χ²=2.935	0.087
	是	11（61.1）	39（39.4）
	否	7（38.9）	60（60.6）
饮酒史[例（%）]				χ²=1.733	0.188
	是	7（38.9）	21（21.2）
	否	11（61.1）	78（78.8）
既往史[例（%）]		12（66.7）	59（59.6）	χ²=0.319	0.572
	肾源性	4（22.2）	14（14.1）	χ²=0.269	0.604
	其他	8（44.4）	45（45.5）	χ²=0.006	0.937
	无	6（33.3）	40（40.4）
家族史[例（%）]				χ²=0.022	0.883
	是	3（16.7）	12（12.1）
	否	15（83.3）	87（87.9）
是否曾手术[例（%）]				χ²=24.547	<0.001
	是	12（66.7）	12（12.1）
	否	6（33.3）	87（87.9）
是否曾放疗[例（%）]				χ²=0.000	0.989
	是	2（11.1）	11（11.1）
	否	16（88.9）	88（88.9）
是否曾化疗[例（%）]				χ²=0.624	0.430
	是	10（55.6）	45（45.5）
	否	8（44.4）	54（54.5）

指标	例数	PT（s）	APTT（s）	PLT（×10⁹/L）
枸橼酸抗凝组	18	13.40（12.45，18.18）	38.95（30.98，54.30）	161.50（49.25，232.25）
低分子肝素抗凝组	99	15.50（13.00，18.90）	40.0（31.20，51.10）	82.00（40.00，187.00）
Z值		-1.606	-0.128	-1.50
P值		0.108	0.898	0.134

指标	例数	PT（s）	APTT（s）	PLT（×10⁹/L）
枸橼酸抗凝组	18	13.40（12.45，18.18）	38.95（30.98，54.30）	161.50（49.25，232.25）
低分子肝素抗凝组	99	15.50（13.00，18.90）	40.0（31.20，51.10）	82.00（40.00，187.00）
Z值		-1.606	-0.128	-1.50
P值		0.108	0.898	0.134

组别		例数	PT变化[s，M（Q_R）]	APTT变化[s，M（Q_R）]	PLT变化[×10⁹/L，M（Q_R）]	血红蛋白浓度变化[g/L，M（Q_R）]
枸橼酸抗凝组		18	0.45（-0.45，1.19）	-0.94（-3.40，3.38）	-46.79（-63.50，-10.18）	-0.48（-12.25，10.50）
低分子肝素抗凝组		99	0.78（0.00，0.78）	9.11（3.90，9.11）	-28.17（-44.00，-4.00）	-3.93（-10.00，-1.00）
	统计值		Z=-0.561	Z=-4.001	Z=-1.804	Z=-1.104
	P值		0.575	<0.001	0.071	0.270
组别		例数	ICU停留时间[d，M（Q_R）]	住院时间[d，M（Q_R）]	血滤器寿命[h，M（Q_R）]	出血发生率[%（例/例）]	死亡率[%（例/例）]
枸橼酸抗凝组		18	11.00（5.00，24.5）	15.00（5.00，25.00）	29.64（19.47，38.94）	38.9（7/18）	33.3（6/18）
低分子肝素抗凝组		99	7.00（3.00，17.00）	13.00（4.00，21.00）	17.00（9.50，24.40）	33.3（33/99）	42.4（42/99）
	统计值		Z=-1.106	Z=-0.637	Z=-3.468	χ²=0.295	χ²=0.520
	P值		0.269	0.524	0.001	0.587	0.471

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