L'anticoagulació en la teràpia continua de reemplaçament renal. Seguretat i eficàcia dels citrats versus heparina: revisió bibliogràfica

Pujol Jofré, Oriol
Introduction: Continued renal replacement therapy has long been used to address acute kidney disease, a pathology with a high number of patients admitted to an ICU. The main problem of this therapy is the coagulation of the filters and circuits, indispensable components for the treatment. Two major anticoagulants are used to prevent this situation: heparin and citrates. Although heparin is the most commonly used, user friendly and older drug, citrates have recently begun to be recommended as first-line anticoagulants, thus outperforming heparin. Regional citrate anticoagulation (RCA) is a treatment that is still under debate and its implementation is considered complex. However, the scientific community observed many benefits and a positive impact on the use of ARC compared to heparin. Objective: To determine the effectiveness of systemic anticoagulation with heparin versus regional citrate anticoagulation. Methodology: A bibliographic review was performed using the databases PubMed, Web of science, BMC, Cochrane Library and the Trip medical database during January and February 2020. Then, the published articles in these databases during the last 10 years were selected. Results: A total of 15 articles that met the inclusion criteria were selected, of which 2 are literature reviews, 2 meta-analyses, 1 systematic review, 4 randomized clinical trials and 6 observational studies. Conclusions: Despite existing discussions, it seems clear that citrate treatment offers numerous advantages in comparison to systemic heparin treatment. On the one hand, citrates increase treatment efficiency, since they allow to extend materials shelf-life and this reduces the used material. In addition, citrate treatment enables to reduce treatment interruptions, resulting in a more rigorous treatment pattern for the patients. On the other hand, citrate treatment is considered safe, since it drastically reduces the risk of bleeding as well as the incidence of treatment-derived metabolic disorders. Finally, a small incidence of citrate accumulation and hyponatremia were observed, risks that healthcare professionals are currently facing ​
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