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Citrate anticoagulation

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https://www.readbyqxmd.com/read/29351783/simple-citrate-anticoagulation-protocol-for-low-flux-haemodialysis
#1
Eng Kuang Lim, Ying-Ying T Seow, Shun E Chen, Gao Yang, Min Er Liaw, Shimi Isaac
BACKGROUND: For patients unable to receive heparin anticoagulation during haemodialysis, saline flushes to reduce circuit clotting are often the norm. Regional citrate anticoagulation (RCA) although effective is not used by many centres including in Singapore. We wanted to demonstrate the superiority and safety of a simple regional citrate anticoagulation regime, compared to saline flushes, for heparin-free low flux haemodialysis. METHODS: This is a prospective, open label, cross over study on 25 sequential haemodialysis sessions for inpatients receiving heparin-free haemodialysis...
January 19, 2018: BMC Nephrology
https://www.readbyqxmd.com/read/29346619/spurious-thrombocytopenia-in-automated-platelet-count
#2
Lixia Zhang, Jian Xu, Li Gao, Shiyang Pan
Spurious thrombocytopenia is a well-known phenomenon observed with the widespread use of hematology analyzers (HAs). In this study, 355 specimens with pseudo-thrombocytopenia (PTCP) were evaluated via epidemiology, identification, remedies, and platelet (PLT) count. Data showed that anticoagulants such as citrate and/or heparin-dependent PTCP (16.0%) became increasingly common, whereas ethylenediaminetetraacetic acid (EDTA)-induced PTCP (49.1%) remained the most frequent. We note that that nearly half of the patients with PTCP had veritable decreased PLT counts, even after PLT levels had been corrected...
January 13, 2018: Laboratory Medicine
https://www.readbyqxmd.com/read/29337813/heparin-free-regional-anticoagulation-there-are-significant-differences-between-citrate-containing-dialysate-and-regional-citrate-anticoagulation
#3
Jakob Gubensek, Jadranka Buturovic-Ponikvar
No abstract text is available yet for this article.
February 2018: Critical Care Medicine
https://www.readbyqxmd.com/read/29324487/renal-replacement-therapy-in-critically-ill-patients-who-when-why-and-how
#4
Melanie Meersch, Alexander Zarbock
PURPOSE OF REVIEW: The increasing incidence of acute kidney injury has the immediate effect of a growing need for renal replacement therapy (RRT). Shedding light on the questions of who, when, why, and how RRT should be performed is difficult to accomplish because of ambiguous study results, poor quality evidence, and low standardization. RECENT FINDINGS: Critically ill patients are exposed to multiple factors known to deteriorate kidney function. Especially severe fluid overload is strongly associated with worse outcome and may be considered as a trigger for initiating RRT...
January 10, 2018: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/29277535/determination-of-dolutegravir-s-unbound-fraction-in-human-plasma-using-validated-equilibrium-dialysis-and-lc-ms-ms-methods
#5
David Metsu, Thomas Lanot, François Fraissinet, Mélanie Picot, Didier Concordet, Marion Cabrol, Frédérique Dubois-Galopin, Etienne Chatelut, Pierre Delobel, Peggy Gandia
Assessment of the unbound pharmacologically active fraction (fu; as the ratio of unbound to total concentration) of dolutegravir could improve therapeutic drug monitoring (TDM) in patients that experience virological failure or toxicity, despite receiving adequate total concentrations. This study evaluated (i) dolutegravir's fu through equilibrium dialysis (ED), (ii) the pre-analytical parameters that influence fu, and (iii) fu's inter-individual variability in HIV patients. Validation of the LC-MS/MS method followed FDA guidelines...
December 22, 2017: Clinica Chimica Acta; International Journal of Clinical Chemistry
https://www.readbyqxmd.com/read/29276240/compatibility-stability-and-efficacy-of-vancomycin-combined-with-gentamicin-or-ethanol-in-sodium-citrate-as-a-catheter-lock-solution
#6
Yangjie Wei, Joshua WonJoon Yang, Sai Hs Boddu, Rose Jung, Mariann D Churchwell
Background: Indwelling catheters deliver lifesaving medical treatments for many chronically ill patients but are frequently a source of infection. Treatment may include an antimicrobial agent(s) and anticoagulant solution dwelling within the catheter. In vitro determinations of solution compatibility and stability are necessary prior to use in patients. Objective: The aim of this study was to determine the physical compatibility, chemical stability, and antimicrobial activity of vancomycin (5 or 10 mg/mL) with gentamicin (1 mg/mL) or 40% ethanol in 4% sodium citrate lock solution over 72 hours...
November 2017: Hospital Pharmacy
https://www.readbyqxmd.com/read/29248145/renal-replacement-therapy-and-anticoagulation
#7
REVIEW
Timo Brandenburger, Thomas Dimski, Torsten Slowinski, Detlef Kindgen-Milles
Today, up to 20% of all intensive care unit patients require renal replacement therapy (RRT), and continuous renal replacement therapies (CRRT) are the preferred technique. In CRRT, effective anticoagulation of the extracorporeal circuit is mandatory to prevent clotting of the circuit or filter and to maintain filter performance. At present, a variety of systemic and regional anticoagulation modes for CRRT are available. Worldwide, unfractionated heparin is the most widely used anticoagulant. All systemic techniques are associated with significant adverse effects...
September 2017: Best Practice & Research. Clinical Anaesthesiology
https://www.readbyqxmd.com/read/29238189/diethyl-citrate-and-sodium-citrate-reduce-the-cytotoxic-effects-of-nanosized-hydroxyapatite-crystals-on-mouse-vascular-smooth-muscle-cells
#8
Chong-Yu Zhang, Xin-Yuan Sun, Jian-Ming Ouyang, Bao-Song Gui
Objective: This study aimed to investigate the damage mechanism of nanosized hydroxyapatite (nano-HAp) on mouse aortic smooth muscle cells (MOVASs) and the injury-inhibiting effects of diethyl citrate (Et2Cit) and sodium citrate (Na3Cit) to develop new drugs that can simultaneously induce anticoagulation and inhibit vascular calcification. Methods: The change in cell viability was evaluated using a cell proliferation assay kit, and the amount of lactate dehydrogenase (LDH) released was measured using an LDH kit...
2017: International Journal of Nanomedicine
https://www.readbyqxmd.com/read/29220362/optimized-plasma-preparation-is-essential-to-monitor-platelet-stored-molecules-in-humans
#9
Marion Mussbacher, Waltraud C Schrottmaier, Manuel Salzmann, Christine Brostjan, Johannes A Schmid, Patrick Starlinger, Alice Assinger
Platelets store a plethora of different molecules within their granules, modulating numerous pathways, not only in coagulation, but also in angiogenesis, wound healing, and inflammatory diseases. These molecules get rapidly released upon activation and therefore represent an easily accessible indirect marker for platelet activation. Accurate analysis of platelet-derived molecules in the plasma requires appropriate anticoagulation to avoid in vitro activation and subsequent degranulation of platelets, potentially causing artificially high levels and masking biologically relevant differences within translational research studies...
2017: PloS One
https://www.readbyqxmd.com/read/29198062/an-evaluation-of-four-modes-of-low-dose-anticoagulation-during-intermittent-haemodialysis
#10
Malin S E Skagerlind, Bernd G Stegmayr
INTRODUCTION: Intensive care participants that need dialysis frequently suffer from increased risk of bleeding. Standard intermittent haemodialysis (SHD) includes anticoagulation to avoid clotting of the dialysis system. The aim of this study was to clarify which of four different low-dose anticoagulant modes was preferable in reducing the exposure to i.v. unfractionated heparin (heparin) and maintaining patency of the dialysis circuit. METHODS: Twenty-three patients on SHD were included to perform haemodialysis with four modes of low-dose anticoagulation...
December 2, 2017: European Journal of Clinical Pharmacology
https://www.readbyqxmd.com/read/29194040/effect-of-preanalytical-and-analytical-variables-on-the-clinical-utility-of-mean-platelet-volume
#11
Mauro Buttarello, Giacomo Mezzapelle, Mario Plebani
BACKGROUND: The study endpoint was to analyze the effect of preanalytical (time, temperature, anticoagulant) and analytical (imprecision, correlation between volume and platelet concentration) variables on mean platelet volume (MPV). A further aim was to calculate in an adult population the reference intervals using the Sysmex XE-5000 analyzer. A critical evaluation was also made of the clinical utility of these parameters. METHODS: Analyses of the above values were performed in duplicate in 170 healthy adults of both sexes: (1) within 30 min from collection, and (2) after 4 h...
December 1, 2017: Clinical Chemistry and Laboratory Medicine: CCLM
https://www.readbyqxmd.com/read/29187232/long-term-continuous-renal-replacement-therapy-and-anticoagulation-with-citrate-in-critically-ill-patients-with-severe-liver-dysfunction
#12
Matthias Klingele, Theresa Stadler, Danilo Fliser, Timo Speer, Heinrich V Groesdonk, Alexander Raddatz
BACKGROUND: As of 2009, anticoagulation with citrate was standard practice in continuous renal replacement therapy (CRRT) for critically ill patients at the University Medical Centre of Saarland, Germany. Partial hepatic metabolism of citrate means accumulation may occur during CRRT in critically ill patients with impaired liver function. The aim of this study was to evaluate the actual influence of hepatic function on citrate-associated complications during long-term CRRT. METHODS: In a retrospective study conducted between January 2009 and November 2012, all cases of dialysis therapy performed in the interdisciplinary surgical intensive care unit were analysed...
November 29, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29185591/safety-and-efficacy-of-regional-citrate-anticoagulation-in-continuous-blood-purification-treatment-of-patients-with-multiple-organ-dysfunction-syndrome
#13
B Tuerdi, L Zuo, H Sun, K Wang, Z Wang, G Li
The aim of this study was to discuss the safety and efficacy of regional citrate anticoagulation (RCA) on continuous blood purification (CBP) during the treatment of multiple organ dysfunction syndrome (MODS). Thirty-five patients with MODS were divided into two groups: the local citrate anticoagulation (RCA) group, and the heparin-free blood purification (hfBP) group. The MODS severity was assessed according to Marshall's MODS score criteria. Blood coagulation indicators, blood pressure, filter lifespan, filter replacement frequency, anticoagulation indicators, and main metabolic and electrolyte indicators were analyzed and compared between RCA and hfBP groups...
November 17, 2017: Brazilian Journal of Medical and Biological Research, Revista Brasileira de Pesquisas Médicas e Biológicas
https://www.readbyqxmd.com/read/29176379/thrombin-generation-estimates-the-anticoagulation-effect-of-direct-oral-anticoagulants-with-significant-interindividual-variability-observed
#14
Joseph Rigano, Cheryl Ng, Harshal Nandurkar, Prahlad Ho
: Direct oral anticoagulants (DOACs) are increasingly being used, primarily due to their drug stability and patient convenience. Although these drugs have been evaluated to be well tolerated in numerous clinical trials, their impact on in-vivo anticoagulation effect, variability and therapeutic drug level remains unknown. Hence, we aim to study the effect and variability of DOACs on thrombin generation via the calibrated automated thrombogram. Anonymized coagulation specimens from outpatients on warfarin were collected...
November 25, 2017: Blood Coagulation & Fibrinolysis: An International Journal in Haemostasis and Thrombosis
https://www.readbyqxmd.com/read/29171099/regional-citrate-anticoagulation-for-intermittent-hemodialysis-in-dogs
#15
T Francey, A Schweighauser
BACKGROUND: The traditional systemic heparinization used for anticoagulation in extracorporeal therapies may cause fatal complications in animals at risk of bleeding. HYPOTHESIS/OBJECTIVES: To develop and validate a protocol of regional citrate anticoagulation (RCA) for intermittent hemodialysis in dogs. ANIMALS: A total of 172 dogs treated with hemodialysis for acute kidney injury. METHODS: In vitro titration was performed, adding trisodium citrate and calcium chloride to heparinized canine blood...
November 24, 2017: Journal of Veterinary Internal Medicine
https://www.readbyqxmd.com/read/29152708/influence-of-sex-on-activated-partial-thromboplastin-time-aptt-and-prothrombin-time-pt-in-sheep
#16
Maria Marília Leite Carlos, Marília Martins Melo, Benito Soto-Blanco
Haemostasis is a physiological process that prevents excessive blood loss. In laboratory, the prothrombin time (PT) and the activated partial thromboplastin time (aPTT) are used to examine clotting systems. However, the influence of sex on PT and aPTT values is unknown. The present work aimed to determine the values for PT and aPTT in adult sheep and to evaluate their dependence on the sex of the animal. Blood samples were collected from 40 adults (1-6 years old) of mixed breed sheep (20 males and 20 females) via jugular venepuncture conducted using vacuum tubes containing 3...
September 30, 2017: Veterinaria Italiana
https://www.readbyqxmd.com/read/29151020/complications-of-regional-citrate-anticoagulation-accumulation-or-overload
#17
Antoine G Schneider, Didier Journois, Thomas Rimmelé
Regional citrate anticoagulation (RCA) is now recommended over systemic heparin for continuous renal replacement therapy in patients without contraindications. Its use is likely to increase throughout the world. However, in the absence of citrate blood level monitoring, the diagnosis of citrate accumulation, the most feared complication of RCA, remains relatively complex. It is therefore commonly mistaken with other conditions. This review aims at providing clarifications on RCA-associated acid-base disturbances and their management at the bedside...
November 19, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29126301/coagulation-testing-in-the-core-laboratory
#18
William E Winter, Sherri D Flax, Neil S Harris
Primary hemostasis begins with endothelial injury. VWF, produced by endothelial cells, binds to platelets and links them to subendothelial collagen. Platelet-derived ADP and thromboxane activate non-adhered platelets via their GPIIb/IIIa receptors, allowing these platelets to participate in platelet aggregation. Secondary hemostasis is initiated with the binding of factor VII to extravascular tissue factor (TF). Factors II, VII, IX and X are vitamin K-dependent factors. The role of vitamin K is to assist in the addition of gamma carboxylate groups to glutamic acids in the "GLA" domains of these factors...
November 8, 2017: Laboratory Medicine
https://www.readbyqxmd.com/read/29123570/cyclophosphamide-and-regional-citrate-anticoagulation-a-sour-combination
#19
Tim Hendra, Jonathan Simon, Alastair Lowe
We present a case of a woman in her 70 s, on cyclophosphamide for multiple myeloma, who was admitted to critical care with grade III acute kidney injury. Renal replacement therapy with regional citrate anticoagulation was commenced. Shortly thereafter her systemic-ionised calcium levels fell and remained stubbornly low until post-filter calcium return was doubled. Her total-to-ionised calcium ratio gradually increased and so, to avoid further accumulation of citrate, anticoagulation was changed to heparin...
November 2017: Journal of the Intensive Care Society
https://www.readbyqxmd.com/read/29118829/evaluating-the-safety-and-efficacy-of-regional-citrate-compared-to-systemic-heparin-as-anticoagulation-for-continuous-renal-replacement-therapy-in-critically-ill-patients-a-service-evaluation-following-a-change-in-practice
#20
Roberta Borg, Debra Ugboma, Dawn-Marie Walker, Richard Partridge
Following the implementation of citrate anticoagulation for continuous renal replacement therapy, we evaluate its first year of use and compare it to the previously used heparin, to assess whether our patients benefit from the recently reported advantages of citrate. We retrospectively analysed 2 years of data to compare the safety and efficacy of citrate versus heparin. The results have shown that 43 patients received continuous renal replacement therapy with heparin, 37 patients with citrate. We found no significant difference in metabolic control of pH, urea and creatinine after 72 h...
August 2017: Journal of the Intensive Care Society
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