{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T19:16:54Z","timestamp":1783538214360,"version":"3.55.0"},"reference-count":37,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T00:00:00Z","timestamp":1783468800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Regional citrate anticoagulation (RCA) is guideline-preferred for continuous renal replacement therapy (CRRT), yet implementation requires expertise, calcium protocols, and reliable monitoring. Evidence for standardized low-molecular-weight heparin strategies without routine anti-Xa monitoring remains limited. Methods: We retrospectively analyzed adult ICU patients receiving protocolized divided-dose enoxaparin during CRRT from January 2020 to December 2024. Enoxaparin 1.5 mg\/kg\/24 h was divided into six equal prefilter doses every 4 h. The primary outcome was circuit clotting; death and hemodynamic instability were treated as competing termination events. Safety endpoints were ISTH major bleeding, clinically relevant non-major bleeding (CRNMB), minor bleeding, thrombosis, and suspected heparin-induced thrombocytopenia (HIT). Results: The cohort included 200 patients and 223 CRRT runs, contributing 8829.8 CRRT-hours. Median run duration was 35.0 h (IQR, 27.2\u201352.1). Circuit clotting occurred in 31 runs (13.9%; 95% CI, 9.6\u201319.1), equivalent to 0.35 events per 100 CRRT-hours. Kaplan\u2013Meier clotting-free survival at 48 h was 89.8% (95% CI, 84.3\u201395.2), and the competing-risk cumulative incidence of clotting was 9.0%. Any classified bleeding occurred in 10 runs (4.5%; 95% CI, 2.2\u20138.1), including one ISTH major bleeding event and one CRNMB event. No thrombotic or HIT events were identified. In a prespecified four-variable Cox model with patient-level cluster-robust standard errors, no predictor was significantly associated with clotting. Conclusions: In a citrate-unavailable or citrate-not-routinely-implemented ICU setting, this standardized divided-dose enoxaparin protocol showed low observed major\/clinically relevant bleeding rates and acceptable clotting-free circuit performance. Prospective comparative evaluation is warranted.<\/jats:p>","DOI":"10.3390\/jcm15145345","type":"journal-article","created":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T17:27:31Z","timestamp":1783531651000},"page":"5345","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Real-World Safety and Circuit Outcomes of Protocolized Divided-Dose Enoxaparin During Continuous Renal Replacement Therapy Without Routine Anti-Xa Monitoring: A Single-Center Competing-Risk Cohort Study"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0285-4109","authenticated-orcid":false,"given":"Hasan Burak","family":"Toprak","sequence":"first","affiliation":[{"name":"Department of Intensive Care, G\u00fclhane Training and Research Hospital, Ankara 06010, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G\u00fcrhan","family":"Ta\u015fk\u0131n","sequence":"additional","affiliation":[{"name":"Department of Intensive Care, G\u00fclhane Training and Research Hospital, Ankara 06010, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammet Alperen","family":"Bayrak","sequence":"additional","affiliation":[{"name":"Department of Intensive Care, G\u00fclhane Training and Research Hospital, Ankara 06010, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahir","family":"Sallan","sequence":"additional","affiliation":[{"name":"Department of Intensive Care, G\u00fclhane Training and Research Hospital, Ankara 06010, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-5065-5782","authenticated-orcid":false,"given":"Oya","family":"Kocakanat","sequence":"additional","affiliation":[{"name":"Department of Intensive Care, G\u00fclhane Training and Research Hospital, Ankara 06010, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mete","family":"Erdemir","sequence":"additional","affiliation":[{"name":"Department of Intensive Care, G\u00fclhane Training and Research Hospital, Ankara 06010, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Levent","family":"Yamanel","sequence":"additional","affiliation":[{"name":"Department of Intensive Care, G\u00fclhane Training and Research Hospital, Ankara 06010, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,8]]},"reference":[{"key":"ref_1","unstructured":"(2012). 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