Child ; Humans ; Anticoagulants/therapeutic use*

Anticoagulants ; therapeutic use ; Humans ; Platelet Aggregation Inhibitors ; therapeutic use ; Stents

Anticoagulants ; therapeutic use ; Humans ; Venous Thrombosis ; drug therapy

Anticoagulants ; therapeutic use ; Coronary Artery Disease ; prevention & control ; Humans

Anticoagulants ; pharmacology ; therapeutic use ; Cardiovascular Diseases ; drug therapy ; Humans

Anticoagulants ; therapeutic use ; Child ; Humans ; Kidney Transplantation ; methods ; mortality ; Prognosis

Humans ; Factor XI ; Thromboembolism/drug therapy* ; Anticoagulants/therapeutic use*

Acute Coronary Syndrome ; drug therapy ; Anticoagulants ; therapeutic use ; Humans ; Polysaccharides ; therapeutic use

Anticoagulants ; therapeutic use ; Atrial Fibrillation ; drug therapy ; Female ; Fibrinolytic Agents ; therapeutic use ; Humans

BACKGROUNDUnfractionated heparin is the most commonly used anticoagulant in continuous renal replacement therapy (CRRT), but it can increase the risk of bleeding. Citrate is a promising substitute. Our study was to assess the efficacy and safety of citrate versus unfractionated heparin in CRRT.

METHODSWe searched the MEDLINE, the EMBASE, the Cochrane Central Register of Controlled Trials, and the China National Knowledge Infrastructure Database until up to November 2011 for randomized controlled trials comparing citrate with unfractionated heparin in adult patients with acute kidney injury prescribed CRRT. The primary outcome was mortality and the secondary outcomes included circuit survival, control of uremia, risk of bleeding, transfusion rates, acid-base statuses, and disturbance of sodium and calcium homeostasis.

RESULTSFour trials met the inclusion criteria. Meta-analysis found no significant difference between two anticoagulants on mortality. Less bleeding and more hypocalcemic episodes were with citrate. Citrate was superior or comparable to unfractionated heparin in circuit life.

CONCLUSIONSCitrate anticoagulation in CRRT seems to be superior in reducing bleeding risk and with a longer or similar circuit life, although there is more metabolic derangement. Mortality superiority has not been approved.

Anticoagulants ; therapeutic use ; Citric Acid ; therapeutic use ; Heparin ; therapeutic use ; Humans ; Randomized Controlled Trials as Topic ; Renal Replacement Therapy ; methods