{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T21:10:57Z","timestamp":1793394657994,"version":"4.5.0"},"reference-count":25,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,8,19]],"date-time":"2021-08-19T00:00:00Z","timestamp":1629331200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,8,19]],"date-time":"2021-08-19T00:00:00Z","timestamp":1629331200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100005640","name":"Faculdade de Medicina da Universidade de S\u00e3o Paulo","doi-asserted-by":"publisher","award":["CG 19.108"],"award-info":[{"award-number":["CG 19.108"]}],"id":[{"id":"10.13039\/501100005640","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Crit Care"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Coronavirus disease 2019 (COVID-19) may predispose patients to thrombotic events. The best anticoagulation strategy for continuous renal replacement therapy (CRRT) in such patients is still under debate. The purpose of this study was to evaluate the impact that different anticoagulation protocols have on filter clotting risk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This was a retrospective observational study comparing two different anticoagulation strategies (citrate only and citrate plus intravenous infusion of unfractionated heparin) in patients with acute kidney injury (AKI), associated or not with COVID-19 (COV\u2009+\u2009AKI and COV\u2009\u2212\u2009AKI, respectively), who were submitted to CRRT. Filter clotting risks were compared among groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Between January 2019 and July 2020, 238 patients were evaluated: 188 in the COV\u2009+\u2009AKI group and 50 in the COV\u2009\u2212\u2009AKI group. Filter clotting during the first filter use occurred in 111 patients (46.6%). Heparin use conferred protection against filter clotting (HR\u2009=\u20090.37, 95% CI 0.25\u20130.55), resulting in longer filter survival. Bleeding events and the need for blood transfusion were similar between the citrate only and citrate plus unfractionated heparin strategies. In-hospital mortality was higher among the COV\u2009+\u2009AKI patients than among the COV\u2009\u2212\u2009AKI patients, although it was similar between the COV\u2009+\u2009AKI patients who received heparin and those who did not. Filter clotting was more common in patients with D-dimer levels above the median (5990\u00a0ng\/ml). In the multivariate analysis, heparin was associated with a lower risk of filter clotting (HR\u2009=\u20090.28, 95% CI 0.18\u20130.43), whereas an elevated D-dimer level and high hemoglobin were found to be risk factors for circuit clotting. A diagnosis of COVID-19 was marginally associated with an increased risk of circuit clotting (HR\u2009=\u20092.15, 95% CI 0.99\u20134.68).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In COV\u2009+\u2009AKI patients, adding systemic heparin to standard regional citrate anticoagulation may prolong CRRT filter patency by reducing clotting risk with a low risk of complications.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s13054-021-03729-9","type":"journal-article","created":{"date-parts":[[2021,8,19]],"date-time":"2021-08-19T10:04:31Z","timestamp":1629367471000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Continuous renal replacement therapy in COVID-19\u2014associated AKI: adding heparin to citrate to extend filter life\u2014a retrospective cohort study"],"prefix":"10.1186","volume":"25","author":[{"given":"Eduardo de Oliveira","family":"Valle","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carla Paulina Sandoval","family":"Cabrera","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia Coimbra C\u00e9sar de","family":"Albuquerque","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanio Vieira da","family":"Silva","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M\u00e1rcia Fernanda Arantes de","family":"Oliveira","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriel Teixeira Montezuma","family":"Sales","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Igor","family":"Smolentzov","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernardo Vergara","family":"Reichert","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucia","family":"Andrade","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victor Faria","family":"Seabra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paulo Ricardo Gessolo","family":"Lins","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0562-0893","authenticated-orcid":false,"given":"Camila Eleuterio","family":"Rodrigues","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,8,19]]},"reference":[{"issue":"23","key":"3729_CR1","doi-asserted-by":"publisher","first-page":"2033","DOI":"10.1182\/blood.2020006000","volume":"135","author":"JM Connors","year":"2020","unstructured":"Connors JM, Levy JH. 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As it was a retrospective analysis, consent to participate does not apply.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"C.E.R. received fees from Medtronic for providing instruction in catheter insertion. All remaining authors have nothing to disclose.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"299"}}