DOI 10.1007/s00134-003-2047-x

Abstract Objective: To compare the efficacy and safety of adjusted-dose unfractionated heparin with that of regional citrate anticoagulation in in-tensive care patients treated by con-tinuous venovenous hemofiltration (CVVH). Design and setting: Pro-spective, randomized, clinical trial in a 32-bed medical and surgical ICU in a university teaching hospi-tal. Patients: ICU patients with acute renal failure requiring continuous renal replacement therapy, without cirrhosis, severe coagulopathy, or known sensitivity to heparin. Inter-ventions: Before the first CVVH run patients were randomized to receive anticoagulation with heparin or tri-sodium citrate. Patients eligible for another CVVH run received the other study medication in a cross-over fashion until the fourth circuit. Measurements and results: Forty-nine circuits (hemofilters) were ana-lyzed: 23 with heparin and 26 with citrate. The median lifetime of hemofilters was 70 h (interquartile range 44–140) with citrate anti-coagulation and 40 h (17–48) with heparin (p=0.0007). One major bleeding occurred during heparin anticoagulation and one metabolic alkalosis (pH=7.60) was noted with citrate after a protocol violation. Transfusion rates (units of red cells per day of CVVH) were, respec-tively, 0.2 (0.0–0.4) with citrate and 1.0 (0.0–2.0) with heparin (p=0.0008). Conclusions: Regional citrate antico-agulation seems superior to heparin for the filter lifetime and transfusion requirements in ICU patients treated by continuous renal replacement therapy