A new prescription model for regional citrate anticoagulation in therapeutic plasma exchanges.

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Serval ID
serval:BIB_10C455BA2F8D
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
A new prescription model for regional citrate anticoagulation in therapeutic plasma exchanges.
Journal
BMC nephrology
Author(s)
Kissling S., Legallais C., Pruijm M., Teta D., Vogt B., Burnier M., Rondeau E., Ridel C.
ISSN
1471-2369 (Electronic)
ISSN-L
1471-2369
Publication state
Published
Issued date
01/03/2017
Peer-reviewed
Oui
Volume
18
Number
1
Pages
81
Language
english
Notes
Publication types: Journal Article
Publication Status: epublish
Abstract
Regional citrate anticoagulation (RCA) is proposed for various extracorporeal purification techniques to overcome the risk of bleeding that might result from systemic anticoagulation. Yet, no individualized treatment protocol has been proposed for therapeutic plasma exchange (TPE) so far. The objective of this study was to assess the determinants of blood citrate concentration needed and to develop an individualized RCA protocol useful for clinical practice.
The study population included 14 patients who underwent a total of 47 TPE sessions. Citrate was infused pre-plasmafilter. Post-plasmafilter and systemic plasma ionized calcium concentrations were measured at standardized time intervals. An algorithm was proposed for the supplementation of calcium. During the discovery phase, citrate was infused at a fixed starting rate, and adapted accordingly to obtained post-plasmafilter ionized calcium levels. Using a mathematical approach, an algorithm was thereafter developed for individualized prescriptions of citrate.
Pre-treatment values of hematocrit and plasma ionized calcium were the main determinants of the required rate of citrate infusion. These can be integrated into a final equation enabling to individualize the prescription. A prefilter ionized calcium concentration between 0.24 and 0.33 mmol/l prevented coagulation of the extracorporeal circuit. Significant hypocalcemia occurred in 8.5% of treatments. There were no significant acid-base disturbances.
We propose a new protocol, which enables for the first time to individualize the prescription of regional citrate anticoagulation during TPE, in an efficient manner. The immediately obtained regional anticoagulation protects against both the risk of coagulation of the membrane and the exposure to an excess of citrate.
Keywords
Adult, Aged, Algorithms, Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/therapy, Anticoagulants/administration & dosage, Calcium/administration & dosage, Citric Acid/administration & dosage, Clinical Protocols, Female, Graft Rejection/therapy, Hemorrhage/prevention & control, Humans, Male, Middle Aged, Plasma Exchange/methods, Thrombotic Microangiopathies/therapy, Citrate, Clinical protocol, Drug prescription, Mathematical model, Plasma exchanges
Pubmed
Web of science
Open Access
Yes
Create date
14/03/2017 18:10
Last modification date
10/06/2020 5:20
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