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Title of Journal: Intensive Care Med

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Abbravation: Intensive Care Medicine

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Springer-Verlag

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DOI

10.1007/s11270-013-1441-4

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1432-1238

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Efficacy and safety of regional citrate anticoagul

Authors: Zhongheng Zhang Ni Hongying
Publish Date: 2011/11/29
Volume: 38, Issue: 1, Pages: 20-28
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Abstract

Regional citrate anticoagulation RCA is an attractive anticoagulation mode in continuous renal replacement therapy CRRT because it restricts the anticoagulatory effect to the extracorporeal circuit In recent years several randomized controlled trials have been conducted to investigate its superiority over other anticoagulation modes Thus we performed a systematic review of available evidence on the efficacy and safety of RCAA systematic review of randomized controlled trials investigating the efficacy and safety of RCA was performed PubMed Current Contents CINAHL and EMBASE databases were searched to identify relevance articles Data on circuit life span bleeding events metabolic derangement and mortality were abstracted Mean difference was used for continuous variables and risk ratio was used for binomial variables The random effects or fixed effect model was used to combine these data according to heterogeneity The software Review Manager 51 was used for the metaanalysisSix studies met our inclusion criteria which involved a total of 658 circuits In these six studies patients with liver failure or a high risk of bleeding were excluded The circuit life span in the RCA group was significantly longer than that in the control group with a mean difference of 2303 h 95 CI 045–4561 h RCA was able to reduce the risk of bleeding with a risk ratio of 028 95 CI 015–050 Metabolic stability electrolyte and acid–base stabilities in performing RCA was comparable to that in other anticoagulation modes and metabolic derangements hypernatremia metabolic alkalosis and hypocalcemia could be easily controlled without significant clinical consequences Two studies compared mortality rate between RCA and control groups with one reported similar mortality rate and the other reported superiority of RCA over the control group hazards ratio 07RCA is effective in maintaining circuit patency and reducing the risk of bleeding and thus can be recommended for CRRT if and when metabolic monitoring is adequate and the protocol is followed However the safety of citrate in patients with liver failure cannot be concluded from current analysis The metabolic stability can be easily controlled during RCA Survival benefit from RCA is still controversial due to limited evidence

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