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Regional Citrate Anticoagulation and Systemic Anticoagulation during Pediatric Continuous Renal Replacement Therapy: A Systematic Literature Review

Background: Clotting is a major drawback of continuous renal replacement therapy (CRRT) performed on critically ill pediatric patients. Although anticoagulation is recommended to prevent clotting, limited results are available on the effect of each pharmacological strategy in reducing filter clottin...

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Autores principales: Buccione, Emanuele, Bambi, Stefano, Rasero, Laura, Tofani, Lorenzo, Piazzini, Tessa, Della Pelle, Carlo, El Aoufy, Khadija, Ricci, Zaccaria, Romagnoli, Stefano, Villa, Gianluca
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9181744/
https://www.ncbi.nlm.nih.gov/pubmed/35683511
http://dx.doi.org/10.3390/jcm11113121
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author Buccione, Emanuele
Bambi, Stefano
Rasero, Laura
Tofani, Lorenzo
Piazzini, Tessa
Della Pelle, Carlo
El Aoufy, Khadija
Ricci, Zaccaria
Romagnoli, Stefano
Villa, Gianluca
author_facet Buccione, Emanuele
Bambi, Stefano
Rasero, Laura
Tofani, Lorenzo
Piazzini, Tessa
Della Pelle, Carlo
El Aoufy, Khadija
Ricci, Zaccaria
Romagnoli, Stefano
Villa, Gianluca
author_sort Buccione, Emanuele
collection PubMed
description Background: Clotting is a major drawback of continuous renal replacement therapy (CRRT) performed on critically ill pediatric patients. Although anticoagulation is recommended to prevent clotting, limited results are available on the effect of each pharmacological strategy in reducing filter clotting in pediatric CRRT. This study defines which anticoagulation strategy, between regional citrate anticoagulation (RCA) and systemic anticoagulation with heparin, is safer and more efficient in reducing clotting, patient mortality, and treatment complications during pediatric CRRT. Methods: A systematic literature review was run considering papers published in English until December 2021 and describing patients’ and treatments’ complications in CRRT performed with heparin and RCA on patients aged less than 18 years. Results: Eleven studies were considered, cumulatively comprising 1.706 CRRT sessions (62% with systemic anticoagulation and 38% with RCA). Studies have consistently identified RCA’s superiority over systemic anticoagulation with heparin in prolonging circuit life. The pooled estimate (95% CI) of filter clotting risk showed that RCA is a protective factor for clotting risk (RR = 0.204). Conclusions: RCA has a potential role in prolonging circuit life and seems superior to systemic anticoagulation with heparin in decreasing the risk of circuit clotting during CRRT performed in critically ill pediatric patients.
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spelling pubmed-91817442022-06-10 Regional Citrate Anticoagulation and Systemic Anticoagulation during Pediatric Continuous Renal Replacement Therapy: A Systematic Literature Review Buccione, Emanuele Bambi, Stefano Rasero, Laura Tofani, Lorenzo Piazzini, Tessa Della Pelle, Carlo El Aoufy, Khadija Ricci, Zaccaria Romagnoli, Stefano Villa, Gianluca J Clin Med Systematic Review Background: Clotting is a major drawback of continuous renal replacement therapy (CRRT) performed on critically ill pediatric patients. Although anticoagulation is recommended to prevent clotting, limited results are available on the effect of each pharmacological strategy in reducing filter clotting in pediatric CRRT. This study defines which anticoagulation strategy, between regional citrate anticoagulation (RCA) and systemic anticoagulation with heparin, is safer and more efficient in reducing clotting, patient mortality, and treatment complications during pediatric CRRT. Methods: A systematic literature review was run considering papers published in English until December 2021 and describing patients’ and treatments’ complications in CRRT performed with heparin and RCA on patients aged less than 18 years. Results: Eleven studies were considered, cumulatively comprising 1.706 CRRT sessions (62% with systemic anticoagulation and 38% with RCA). Studies have consistently identified RCA’s superiority over systemic anticoagulation with heparin in prolonging circuit life. The pooled estimate (95% CI) of filter clotting risk showed that RCA is a protective factor for clotting risk (RR = 0.204). Conclusions: RCA has a potential role in prolonging circuit life and seems superior to systemic anticoagulation with heparin in decreasing the risk of circuit clotting during CRRT performed in critically ill pediatric patients. MDPI 2022-05-31 /pmc/articles/PMC9181744/ /pubmed/35683511 http://dx.doi.org/10.3390/jcm11113121 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Systematic Review
Buccione, Emanuele
Bambi, Stefano
Rasero, Laura
Tofani, Lorenzo
Piazzini, Tessa
Della Pelle, Carlo
El Aoufy, Khadija
Ricci, Zaccaria
Romagnoli, Stefano
Villa, Gianluca
Regional Citrate Anticoagulation and Systemic Anticoagulation during Pediatric Continuous Renal Replacement Therapy: A Systematic Literature Review
title Regional Citrate Anticoagulation and Systemic Anticoagulation during Pediatric Continuous Renal Replacement Therapy: A Systematic Literature Review
title_full Regional Citrate Anticoagulation and Systemic Anticoagulation during Pediatric Continuous Renal Replacement Therapy: A Systematic Literature Review
title_fullStr Regional Citrate Anticoagulation and Systemic Anticoagulation during Pediatric Continuous Renal Replacement Therapy: A Systematic Literature Review
title_full_unstemmed Regional Citrate Anticoagulation and Systemic Anticoagulation during Pediatric Continuous Renal Replacement Therapy: A Systematic Literature Review
title_short Regional Citrate Anticoagulation and Systemic Anticoagulation during Pediatric Continuous Renal Replacement Therapy: A Systematic Literature Review
title_sort regional citrate anticoagulation and systemic anticoagulation during pediatric continuous renal replacement therapy: a systematic literature review
topic Systematic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9181744/
https://www.ncbi.nlm.nih.gov/pubmed/35683511
http://dx.doi.org/10.3390/jcm11113121
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