Monitoring of Enoxaparin during Hemodialysis Covered by Regional Citrate Anticoagulation in Acute Kidney Injury: A Prospective Cohort Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Eligible Patients and Exclusion Criteria
2.2. Parameters Collected for Evaluation
2.3. Laboratory Assessments and Reference Ranges (RR)
2.4. Diagnosis of Venous Thromboembolism
2.5. Statistical Analysis
3. Results
3.1. Patient Characteristics
3.2. Anti-Xa Levels during CRRT
3.3. ROTEM Parameters during CRRT
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Appendix A
References
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N | Median | Male | Female | p Value | |
---|---|---|---|---|---|
Sex | n/a | n/a | 16 | 13 | n/a |
Age (years) | 29 | 66 (58; 72) | 67 (63; 72) | 65 (56; 73) | 0.83 |
BMI | 29 | 25.7 (24.4; 29) | 25 (24.1; 27.9) | 28.4 (25; 31.1) | 0.23 |
SAPS III | 29 | 65 (59.5; 80) | 62 (55; 72) | 71 (62; 80) | 0.16 |
Caprini score | 29 | 8 (6; 9) | 9 (6; 9) | 8 (6; 9) | 0.4 |
N | Baseline | Day A | Day B | Day C | p | |
---|---|---|---|---|---|---|
Renal function, fluid balance, vasopressor therapy | ||||||
BUN (mg dL−1) | 27 | 74.0 (37.1; 99.6) | 42.0 (28.1; 61.1) | 26.2 (22.1; 37.0) | 22.8 (18.6; 29.8) | <0.001 |
Creatinine (mg dL−1) | 27 | 3.09 (2.36; 4.50) | 2.01 (1.76; 2.69) | 1.40 (1.22; 1.95) | 1.36 (1.02; 2.03) | <0.001 |
Urine output (mL day−1) | 25 | 630 (275; 1043) | 380 (230; 750) | 220 (59; 525) | 150 (0; 410) | <0.001 |
Blood flow rates, CVVHD (mL min−1) | 29 | n/a | 100 (100;100) | 100 (100; 100) | 100 (100;100) | n/a |
Fluid balance (mL day−1) | 24 | 1560 (217; 2896) | 690 (−522; 2456) | 7 (−392; 659) | −326 (−1326; 383) | 0.16 |
Norepinephrine (n) | 29 | 15 | 14 | 10 | 7 | n/a |
Norepinephrine (mcg kg−1 min−1) | 29 | 0.003 (0; 0.23) | 0 (0; 0.08) | 0 (0; 0.05) | 0 (0; 0.05) | n/a |
Conventional coagulation assays and platelet counts | ||||||
PT Owren (%) | 27 | 62 (47; 86) | 70 (50;87) | 73 (55; 91) | 79 (63; 92) | 0.14 |
aPTT (s) | 27 | 39.3 (36.9; 47.9) | 41.9 (38.4; 46.4) | 40.2 (37.9; 46.8) | 38.6 (35.1; 43) | 0.46 |
Fibrinogen (mg dL−1) | 27 | 509 (390; 652) | 558 (378; 689) | 574 (416; 673) | 579 (454; 650) | 0.95 |
AT III (%) | 26 | 64 (45; 97) | 68 (50; 105) | 71 (58; 93) | 86 (63; 98) | 0.06 |
Platetet count (G L−1) | 27 | 183 (106; 230) | 180 (108; 222) | 161 (109; 196) | 142 (123; 193) | 0.12 |
Procoagulant drugs (number of patients receiving ≥ 1 application) | ||||||
Tranexamic acid | 1 | 1 | 0 | 0 | 0 | n/a |
Fibrinogen concentrate | 2 | 1 | 1 | 0 | 0 | n/a |
Prothrombin complex concentrate | 1 | 1 | 0 | 0 | 0 | n/a |
AT III concentrate | 2 | 2 | 0 | 0 | 0 | n/a |
Blood products (number of patients receiving > 2 units) | ||||||
Packed red blood cells (PRBC) | 3 | 3 | 1 | 0 | 0 | n/a |
Platelet concentrates | 0 | 0 | 0 | 0 | 0 | n/a |
Fresh frozen plasma | 1 | 0 | 0 | 1 | 0 | n/a |
N | Baseline | Day A | Day B | Day C | p Value | |
---|---|---|---|---|---|---|
Standard assay of extrinsically activated thromboelastometry (EXTEM) | ||||||
CT (s) | 22 | 71 (64; 83) | 75 (61; 87) | 67 (58; 80) | 63 (51; 89) | 0.37 |
CFT (s) | 22 | 68 (52; 116) | 66 (47; 100) | 62 (48; 98) | 63 (52; 86) | 0.59 |
MCF (mm) | 22 | 74 (62; 77) | 71 (63; 78) | 74 (61; 79) | 74 (67; 79) | 0.74 |
maxV (mm s−1) | 17 | 19 (14; 25) | 23 (16; 29) | 22 (14; 28) | 23 (20; 27) | 0.15 |
maxVt (s) | 17 | 104 (89; 144) | 109 (89; 142) | 97 (85; 125) | 92 (68; 124) | 0.15 |
Modified assay of low-tissue-factor thromboelastometry (low-TF ROTEM) | ||||||
CT (s) | 22 | 602 (471; 845) | 667 (504; 758) | 656 (504; 809) | 568 (491; 910) | 0.97 |
CFT (s) | 22 | 199 (140; 345) | 220 (174; 386) | 238 (186; 381) | 231 (158; 370) | 0.63 |
MCF (mm) | 20 | 61 (52; 71) | 58 (54; 70) | 64 (54; 75) | 68 (57; 74) | 0.32 |
maxV (mm s−1) | 15 | 9 (5; 16) | 8 (6; 11) | 9 (5; 13) | 11 (7; 13) | 0.89 |
maxVt (s) | 15 | 786 (575; 1019) | 814 (669; 961) | 795 (623; 1153) | 727 (652; 1012) | 0.9 |
Modified assay of prothrombinase-induced clotting (PiCT) | ||||||
CT (s) | 22 | 257 (207; 343) | 263 (201; 381) | 251 (214; 346) | 234 (212; 314) | 0.63 |
CFT (s) | 22 | 137 (85; 179) | 130 (83; 249) | 145 (103; 184) | 152 (109; 227) | 0.1 |
MCF (mm) | 21 | 69 (58; 75) | 69 (59; 72) | 68 (57; 75) | 70 (57; 74) | 0.19 |
maxV (mm s−1) | 16 | 15 (10; 18) | 11 (8; 18) | 15 (11; 22) | 13 (9; 18) | 0.19 |
maxVt (s) | 16 | 343 (298; 448) | 342 (279; 482) | 337 (273; 473) | 322 (265; 403) | 0.98 |
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Wiegele, M.; Adelmann, D.; Dibiasi, C.; Pausch, A.; Baierl, A.; Schaden, E. Monitoring of Enoxaparin during Hemodialysis Covered by Regional Citrate Anticoagulation in Acute Kidney Injury: A Prospective Cohort Study. J. Clin. Med. 2021, 10, 4491. https://doi.org/10.3390/jcm10194491
Wiegele M, Adelmann D, Dibiasi C, Pausch A, Baierl A, Schaden E. Monitoring of Enoxaparin during Hemodialysis Covered by Regional Citrate Anticoagulation in Acute Kidney Injury: A Prospective Cohort Study. Journal of Clinical Medicine. 2021; 10(19):4491. https://doi.org/10.3390/jcm10194491
Chicago/Turabian StyleWiegele, Marion, Dieter Adelmann, Christoph Dibiasi, Andrè Pausch, Andreas Baierl, and Eva Schaden. 2021. "Monitoring of Enoxaparin during Hemodialysis Covered by Regional Citrate Anticoagulation in Acute Kidney Injury: A Prospective Cohort Study" Journal of Clinical Medicine 10, no. 19: 4491. https://doi.org/10.3390/jcm10194491