Comparison of curative effect between different anticoagulation regimens in continuous renal replacement therapy after cardiac valve replacement.

Objectives: To compare the clinical effect of low molecular weight heparin (LMWH) and regional citrate anticoagulation (RCA) in continuous renal replacement therapy (CRRT) after heart valve replacement.

Methods: Retrospective analysis of clinical data from 60 patients undergoing continuous renal replacement therapy after heart valve replacement in Peking University Shenzhen Hospital from January 2015 to July 2019, including 35 males and 25 females, aged (58.83 ±16.36) years. The patients were divided into a LMWH group and a RCA group according to the anticoagulation regimen, with 30 patients in each group. The 24 h postoperative drainage volume (pericardium, mediastinum), postoperative ventilator use time and ICU stay time, incidence of postoperative respiratory tract bleeding and gastrointestinal bleeding, postoperative skin ecchymosis incidence and mortality between the 2 groups were compared; the thromboplastin time (APTT), fibrinogen (FIB), thrombin time (TT), prothrombin time (PT), international normalized ratio (INR), and PLT between the 2 groups after anticoagulation treatment were compared; the service life of dialysis filters and CRRT time between the 2 groups were compared; and the levels of urea nitrogen and serum creatinine between the 2 groups before and after treatment were also compared.

Results: After anticoagulant treatment, the RCA group had less 24 h postoperative drainage volume than the LMWH group, shorter ventilator use time, ICU stay time, and hospitalization days than the LMWH group, and lower respiratory tract bleeding and gastrointestinal bleeding incidence than the LMWH group, with significant differences (all <0.05); there was no significant difference in the incidence of skin ecchymosis and mortality after treatment between the 2 groups (all >0.05); there was no significant difference in APTT, FIB, and TT between the 2 groups (all >0.05); the PT and INR of the RCA group were higher than those in the LMWH group, while the PLT of RCA group was lower than that in the LMWH group, with significant differences (all <0.05); there was no significant difference in CRRT time between the two groups (=0.073). After the treatment, there were no significant differences in urea nitrogen and serum creatinine levels between the 2 groups (all >0.05).

Conclusions: CRRT after cardiac valve replacement with RCA can effectively reduce pericardial and mediastinal drainage, reduce the risk of bleeding, shorten the time of ventilator use and ICU stay, and promote postoperative recovery of patients, which have positive significance for reducing the burden on patients and their families.