Alternative anticoagulation during extracorporeal detoxification

Abstract

The role of heparin anticoagulation in the development of hemorrhagic syndrome after extracorporeal detoxification (ECD) procedures in patients with initial hemostasis disorders, as well as the place of alternative citrate anticoagulation in extracorporeal treatment have not yet received a final assessment and require further study. The aim of this work was to compare the results of treatment of patients with severe intoxication using heparin and citrate as anticoagulants during ECD procedures. The conducted study confirms that the use of heparin anticoagulation in ECD leads to a spasmodic progression of the manifestations of DIC that were present before the procedure. Citrate anticoagulation demonstrates the benefits consisting in the absence of a spasmodic increase in coagulopathy, hypofibrinemia, and thrombocytopenia during an ECD session, which is characteristic of the heparin use. However, when ECD is initiated against the background of more severe initial coagulopathy and, interrelatedly, more severe multiple organ failure (MOF), this does not improve treatment outcomes. Moreover, among patients with severe MOF taken for ECD, there was a greater mortality rate and a large proportion of deaths during and immediately after the session when using citrate anticoagulation. Thus, ECD procedures with citrate anticoagulation may have a negative impact on the condition of patients who already have severe MOF and severe coagulopathy. This risk may be associated with metabolic disorders, especially dangerous in such severe patients, and does not outweigh the risk of an increase in hemostasis disorders characteristic of heparin anticoagulation. Probably, ECD with citrate anticoagulation has to be carried out at an earlier stage of the disease, and in cases of severe MOF already present in the patient, it is advisable to use traditional heparin anticoagulation.