Effects of regional citrate anticoagulation on thrombin generation, fibrinolysis and platelet function in critically ill patients receiving continuous renal replacement therapy for acute kidney injury: a prospective study

Fisher, Richard; Moore, Gary W.; Mitchell, Michael J.; Dai, Letian; Crichton, Siobhan; Lumlertgul, Nuttha; Ostermann, Marlies

doi:10.1186/s13613-022-01004-w

Annals of Intensive Care

Table 3 Changes in measurements of coagulation over duration of treatment

From: Effects of regional citrate anticoagulation on thrombin generation, fibrinolysis and platelet function in critically ill patients receiving continuous renal replacement therapy for acute kidney injury: a prospective study

	Baseline	12 h	24 h	36 h	48 h	72 h	p value*
Haemoglobin (g/L)	102 (28)	95 (26)	93 (23)	91 (25)	91 (17)	87 (19)	0.017
Haematocrit	0.32 (0.09)	0.29 (0.08)	0.29 (0.07)	0.28 (0.08)	0.28 (0.06)	0.27 (0.06)
Platelets (× 10⁹/L)	233 (164)	187 (114)	176 (104)	173 (107)	174 (110)	169 (95)	0.043
INR
Systemic	1.18 (0.15)	1.13 (0.13)	1.13 (0.13)	1.10 (0.11)	1.08 (0.10)	1.06 (0.09)	0.018
Circuit		1.22 (0.15)	1.15 (0.13)	1.13 (0.11)	1.10 (0.10)	1.08 (0.12)	0.020
APTTr
Systemic	1.29 (0.31)	1.25 (0.37)	1.18 (0.20)	1.11 (0.21)	1.11 (0.18)	1.17 (0.30)	0.077
Circuit		1.33 (0.38)	1.23 (0.24)	1.17 (0.22)	1.20 (0.24)	1.19 (0.28)	0.262
Fibrinogen (g/L)
Systemic	4.81 (1.47)	5.01 (1.67)	5.53 (1.85)	5.25 (1.74)	5.36 (1.64)	5.13 (1.80)	0.868
Circuit		5.12 (1.70)	5.27 (2.07)	5.33 (1.86)	5.42 (1.58)	5.31 (1.93)	0.309
D-Dimer (mg/L)
Systemic	15.8 (15.9)	13.4 (11.8)	16.2 (9.3)	14.4 (9.2)	13.8 (12.8)	15.5 (14.5)	0.984
Circuit		15.4 (13.1)	15.2 (9.3)	13.4 (9.2)	15.1 (14.1)	15.6 (13.9)	0.912
TGA: maximum thrombin generation (nM)**
Systemic	498.5 (390.6)	650.2 (383.8)	631.5 (397.7)	649.9 (443.9)	599.3 (290.3)	557.3 (315.1)	0.948
Circuit		606.4 (422.9)	612.2 (349.7)	678.9 (458.3)	670.8 (249.0)	603.5 (187.6)	0.642
TGA: time to peak thrombin generation (min)**
Systemic	22.9 (10.5)	21.5 (11.2)	26.3 (10.4)	21.7 (8.1)	28.7 (12.4)	31.1 (14.0)	0.186
Circuit		22.7 (11.3)	27.6 (10.7)	21.3 (6.5)	23.2 (12.1)	25.9 (6.5)	0.668
PFSCA CT (s)***
Systemic	127(80)	162 (92)	137 (82)	130 (45)	139 (84)	123 (74)	0.694
Circuit		166 (94)	145 (72)	216 (84)	169 (89)	148 (74)	0.126
PFSCE CT (s)****
Systemic	140 (85)	160 (77)	159 (75)	198 (69)	138 (36)	155 (73)	0.200
Circuit		176 (87)	170 (82)	169 (80)	162 (64)	175 (68)	0.970

INR International Normalised Ratio, APTTr activated partial thromboplastin time ratio, TGA thrombin generation assay, PFSCA platelet function assay using collagen/adenosine diphosphate, PFSCE platelet function assay using collagen/epinephrine, CT closure time
^*Repeated measures ANOVAs compared systemic parameters from baseline to 48 h. Post hoc pairwise comparisons found significant differences between haemoglobin at baseline and 36 h (p = 0.030) and baseline and 48 h (p = 0.018); platelets at baseline and 36 h (p = 0.035) and baseline and 48 h (p = 0.040) and INR at baseline and 36 h (p = 0.034) and baseline and 48 h (p = 0.024). There were no significant differences in systemic parameters on CRRT. Repeated measures ANOVAs of measurements from the circuit compared data from 12 to 48 h. Only INR differed overtime, with a significant difference between 12 and 48 h in post hoc comparisons (p = 0.002)
^**Test failed to return a result in 6.8% of samples (8/117)
^***Test exceeded maximum permitted duration in 25.6% of samples (30/117); lower bound for duration of 300 s was used in analysis
^****Test exceeded maximum permitted duration in 27.4% of samples (32/117), lower bound for duration of 300 s was used in analysis

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