Non-anticoagulant factors affecting coagulation in the extracorporeal circulation circuit and the development of an individualized regional citrate anticoagulation protocol for hemodialysis: A real-world retrospective study
Research article published in The International journal of artificial organs (2023)
Abstract
OBJECTIVE: To investigate non-anticoagulant factors that affect blood coagulation in the extracorporeal circulation (ECC) circuit of regional citrate anticoagulation (RCA) protocol for hemodialysis (HD). METHOD: The clinical characteristics of patients undergoing an individualized RCA protocol for HD between February 2021 and March 2022 were collected; Coagulation scores, pressures in various parts of the ECC circuit, the incidence of coagulation, and citrate concentrations in the ECC circuit during treatment were determined, and non-anticoagulant factors affecting coagulation in the ECC circuit were analyzed. RESULT: The lowest clotting rate was 2.8% in patients with arteriovenous fistula in various vascular access. Patients on Fresenius dialysis had a lower rate of clotting in the cardiopulmonary bypass line than patients on other brands of dialyzer. Low-throughput dialyzers are less likely to clot than high-throughput dialyzers. There are significant differences in the incidence of coagulation among different nurses during citrate anticoagulant hemodialysis. CONCLUSION: In the process of citrate anticoagulant hemodialysis, non-anticoagulant factors such as coagulation status, vascular access, dialyzer selection, and operator quality will affect the anticoagulant effect.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Summary
Peer-reviewed clinical and outcomes research relevant to medicinal leech therapy and its biology. Indexed in PubMed and verified against the NCBI record.
Why This Matters for Hirudotherapy
This study examined non-anticoagulant factors influencing blood coagulation in extracorporeal circulation circuits during regional citrate anticoagulation hemodialysis, analyzing coagulation scores, circuit pressures, and clotting incidence in patients treated between February 2021 and March 2022. The investigators reported a lowest clotting rate of 2.8% among patients with arteriovenous fistulas, lower clotting with Fresenius dialyzers versus other brands and with low-throughput versus high-throughput dialyzers, and significant variation in coagulation incidence among different nurses. For ASH and hirudotherapy, this work is relevant because it demonstrates that anticoagulant effectiveness depends substantially on non-pharmacologic variables—vascular access, equipment selection, and operator technique—a principle worth considering when evaluating real-world outcomes of leech-derived anticoagulants such as hirudin. An honest caveat is that this study investigated citrate anticoagulation in hemodialysis circuits, not hirudin or leech therapy directly, and it does not establish causal relationships among the factors identified.
Citation
Non-anticoagulant factors affecting coagulation in the extracorporeal circulation circuit and the development of an individualized regional citrate anticoagulation protocol for hemodialysis: A real-world retrospective study.
Hu et al. · The International journal of artificial organs, 2023
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