A Comparison of the Anticoagulation Efficacy and Safety of Epoprostenol to Heparin and Citrate in Children Receiving Continuous Renal Replacement Therapy.

IF 2.2 3区医学 Q3 HEMATOLOGY Blood Purification Pub Date : 2024-07-18 DOI:10.1159/000540302

Esha Sondhi, Martha Stewart, Jenna Harper, Leslie Konyk, Coleen McSteen, Kelli L Crowley, Nahmah Kim-Campbell, Anthony Fabio, Dana Y Fuhrman

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Abstract

Introduction: Anticoagulants are used in continuous renal replacement therapy (CRRT) to prolong filter life. There are no prior investigations directly comparing epoprostenol to more commonly used forms of anticoagulation in children. Therefore, the primary aim of this study was to assess the efficacy and safety of epoprostenol as compared to heparin and citrate anticoagulation in a pediatric cohort.

Methods: We performed a retrospective analysis of all patients <18 years of age admitted to an academic quaternary care children's hospital from 2017-2022 who received epoprostenol, heparin, or citrate exclusively for CRRT anticoagulation. Efficacy was evaluated by comparing the hours to the first unintended filter change and the ratio of filters used to CRRT days. Safety was assessed by evaluating changes in platelet count and vasoactive-ionotropic score (VIS).

Results: Of 101 patients, 44 received epoprostenol (43.6%), 38 received heparin (37.6%), and 19 received citrate (18.8%). The first filter change was more commonly planned in patients receiving anticoagulation with epoprostenol (43%) as compared to citrate (11%) or heparin (29%) (p = 0.034). Of those patients where the first filter change was unintended (n = 33), there were greater median hours until the filter was replaced in those receiving epoprostenol (29) when compared to citrate (21) (p = 0.002) or heparin (18) (p = 0.003). There was a smaller median ratio of filters used to days on therapy in the patients that received epoprostenol (0.53) when compared to citrate (1) (p = 0.003) or heparin (0.75) (p = 0.001). For those receiving epoprostenol, there was no significant decrease in platelet count when comparing values prior to CRRT initiation through 7 days of therapy. There was no significant difference in VIS when comparing values prior to CRRT initiation through the first 2 days of CRRT.

Conclusions: Epoprostenol-based anticoagulation is effective when compared to other anticoagulation strategies used in pediatric CRRT with a favorable side effect profile.

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在接受持续肾脏替代疗法的儿童中，比较表前列醇与肝素和枸橼酸盐的抗凝效果和安全性。

导言：抗凝剂用于持续肾脏替代疗法（CRRT），以延长滤器寿命。目前还没有研究将依前列醇与更常用的儿童抗凝剂进行直接比较。因此，本研究的主要目的是在儿科人群中评估依前列醇与肝素和枸橼酸抗凝相比的疗效和安全性：我们对2017-2022年在一家学术性四级护理儿童医院住院的所有<18岁患者进行了回顾性分析，这些患者仅接受了依前列醇、肝素或枸橼酸盐的CRRT抗凝治疗。疗效通过比较首次意外更换滤器的时间和滤器使用量与CRRT天数的比率进行评估。安全性通过评估血小板计数和血管活性-肌电位评分（VIS）的变化进行评估：在 101 名患者中，44 人接受了表前列醇治疗（43.6%），38 人接受了肝素治疗（37.6%），19 人接受了枸橼酸盐治疗（18.8%）。与枸橼酸盐（11%）或肝素（29%）相比，接受依前列醇（43%）抗凝治疗的患者更常计划首次更换过滤器（P=0.034）。在首次无意更换过滤器的患者中（人数=33），与枸橼酸盐（21）（P=0.002）或肝素（18）（P=0.003）相比，接受环前列醇（29）的患者更换过滤器的中位时间更长。与枸橼酸盐（1）（p=0.003）或肝素（0.75）（p=0.001）相比，接受环前列醇治疗的患者所用滤器与治疗天数的中位比率（0.53）更小。对于接受环前列醇治疗的患者，如果比较开始 CRRT 治疗前至治疗 7 天的数值，血小板计数没有显著下降。如果比较 CRRT 开始前到 CRRT 开始后 2 天的数值，VIS 没有明显差异：结论：与儿科 CRRT 中使用的其他抗凝策略相比，以表前列醇为基础的抗凝治疗是有效的，而且副作用小。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Blood Purification 医学-泌尿学与肾脏学

CiteScore

5.80

自引率

3.30%

发文量

审稿时长

6-12 weeks

期刊介绍： Practical information on hemodialysis, hemofiltration, peritoneal dialysis and apheresis is featured in this journal. Recognizing the critical importance of equipment and procedures, particular emphasis has been placed on reports, drawn from a wide range of fields, describing technical advances and improvements in methodology. Papers reflect the search for cost-effective solutions which increase not only patient survival but also patient comfort and disease improvement through prevention or correction of undesirable effects. Advances in vascular access and blood anticoagulation, problems associated with exposure of blood to foreign surfaces and acute-care nephrology, including continuous therapies, also receive attention. Nephrologists, internists, intensivists and hospital staff involved in dialysis, apheresis and immunoadsorption for acute and chronic solid organ failure will find this journal useful and informative. ''Blood Purification'' also serves as a platform for multidisciplinary experiences involving nephrologists, cardiologists and critical care physicians in order to expand the level of interaction between different disciplines and specialities.