Key result
Heparin anticoagulation was associated with a higher risk of bleeding episodes compared to regional citrate anticoagulation during membrane therapeutic plasma exchange (16.4% vs 4.4%; OR 5.659; P<0.001).
Why the study?
Opinions were controversial regarding the use of heparin anticoagulation versus regional citrate anticoagulation for membrane therapeutic plasma exchange in patients with increased bleeding risk.
Does regional citrate anticoagulation reduce bleeding episodes compared to heparin anticoagulation in patients with increased bleeding risk undergoing membrane therapeutic plasma exchange?
Cohort (n=108)
No
Does regional citrate anticoagulation reduce bleeding episodes compared to heparin anticoagulation in patients with increased bleeding risk undergoing membrane therapeutic plasma exchange?
Odds Ratio: 5.659 (95% CI 2.266–14.129)
Absolute Event Rate: 16.4% vs 4.4%
p-value: p=<0.001
Regional citrate anticoagulation is as effective as heparin for membrane therapeutic plasma exchange but is associated with a significantly lower risk of bleeding in patients with increased bleeding risk.
May support regional citrate over heparin to reduce bleeding in high-risk mTPE patients; leaves open need for randomized confirmation.
Background Heparin anticoagulation (HA) is commonly employed for membrane therapeutic plasma exchange (mTPE). However, for patients with increased bleeding risk, there were controversial opinions on the use of HA versus regional citrate anticoagulation (RCA) for mTPE. Our present study aimed to evaluate the efficacy and safety of HA vs. RCA for mTPE in patients with increased bleeding risk.Methods Patients with increased bleeding risk who underwent mTPE between 2014 and 2021 in our center were screened. Observations of anticoagulation efficacy and safety were used as the study endpoints.Results A total of 108 patients with 368 mTPE sessions were included. Of the included patients, 38 and 70 received HA and RCA mTPE, respectively. There was no significant difference in the clotting of extracorporeal circuits between the HA and RCA groups (4.1% vs. 4.4%, p = 0.605). More bleeding episodes were observed in the HA group compared to the RCA group (16.4% vs. 4.4% mTPE sessions, p < 0.001). The frequency of postoperative transfusion within 24 h (11% vs. 3.4%, p = 0.007) was significantly different in the HA and RCA group. Anticoagulation strategy (HA vs. RCA; OR 5.659, 95%CI 2.266–14.129; p < 0.001), and mean arterial pressure (prior treatment, OR 1.052, 95%CI 1.019–1.086; p = 0.002) were independent risk factors of bleeding episodes. At the end of mTPE treatment, the incidence of metabolic alkalosis (16.7% vs. 54.1%, p = 0.027) and hypocalcemia (41.7% vs. 89.2%, p = 0.001) was significantly different in the HA (n = 5, 12 sessions) and RCA (n = 22, 74 sessions) groups, respectively.Conclusion RCA is as effective as HA for mTPE. However, for patients with increased bleeding risk, RCA is associated with a lower risk of bleeding, compared with HA. With careful monitoring and timely adjustment, RCA most likely is a safe and effective anticoagulation option for mTPE in patients with increased bleeding risk.
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Jiao et al. (2023) conducted a cohort in Increased bleeding risk requiring membrane therapeutic plasma exchange (n=108). Heparin anticoagulation vs. Regional citrate anticoagulation was evaluated on Bleeding episodes (OR 5.659, 95% CI 2.266-14.129, p=<0.001). Heparin anticoagulation was associated with a higher risk of bleeding episodes compared to regional citrate anticoagulation during membrane therapeutic plasma exchange (16.4% vs 4.4%; OR 5.659; P<0.001).
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