PMID- 33198670 OWN - NLM STAT- MEDLINE DCOM- 20201125 LR - 20240330 IS - 1471-2369 (Electronic) IS - 1471-2369 (Linking) VI - 21 IP - 1 DP - 2020 Nov 16 TI - Comparison of different anticoagulation strategies for renal replacement therapy in critically ill patients with COVID-19: a cohort study. PG - 486 LID - 10.1186/s12882-020-02150-8 [doi] LID - 486 AB - BACKGROUND: Critically ill coronavirus disease 2019 (COVID-19) patients have a high risk of acute kidney injury (AKI) that requires renal replacement therapy (RRT). A state of hypercoagulability reduces circuit life spans. To maintain circuit patency and therapeutic efficiency, an optimized anticoagulation strategy is needed. This study investigates whether alternative anticoagulation strategies for RRT during COVID-19 are superior to administration of unfractionated heparin (UFH). METHODS: Retrospective cohort study on 71 critically ill COVID-19 patients (>/=18 years), admitted to intensive care units at a tertiary health care facility in the southwestern part of Germany between February 26 and May 21, 2020. We collected data on the disease course, AKI, RRT, and thromboembolic events. Four different anticoagulatory regimens were administered. Anticoagulation during continuous veno-venous hemodialysis (CVVHD) was performed with UFH or citrate. Anticoagulation during sustained low-efficiency daily dialysis (SLEDD) was performed with UFH, argatroban, or low molecular weight heparin (LMWH). Primary outcome is the effect of the anticoagulation regimen on mean treatment times of RRT. RESULTS: In patients receiving CVVHD, mean treatment time in the UFH group was 21.3 h (SEM: +/-5.6 h), in the citrate group 45.6 h (SEM: +/-2.7 h). Citrate anticoagulation significantly prolonged treatment times by 24.4 h (P = .001). In patients receiving SLEDD, mean treatment time with UFH was 8.1 h (SEM: +/-1.3 h), with argatroban 8.0 h (SEM: +/-0.9 h), and with LMWH 11.8 h (SEM: +/-0.5 h). LMWH significantly prolonged treatment times by 3.7 h (P = .008) and 3.8 h (P = .002), respectively. CONCLUSIONS: UFH fails to prevent early clotting events in the dialysis circuit during COVID-19. For patients, who do not require effective systemic anticoagulation, regional citrate dialysis is the most effective strategy. For patients, who require effective systemic anticoagulation, the usage of LMWH results in the longest circuit life spans. The proposed anticoagulatory strategies are safe, can easily be monitored, and allow an individualized treatment. FAU - Arnold, Frederic AU - Arnold F AD - Department of Medicine IV: Nephrology and Primary Care, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany. AD - Institute of Medical Microbiology and Hygiene, Faculty of Medicine, University of Freiburg, Freiburg, Germany. AD - Berta-Ottenstein-Programme for Clinician Scientists, Faculty of Medicine, University of Freiburg, Freiburg, Germany. FAU - Westermann, Lukas AU - Westermann L AD - Department of Medicine IV: Nephrology and Primary Care, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany. FAU - Rieg, Siegbert AU - Rieg S AD - Department of Medicine II: Division of Infectious Diseases, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany. FAU - Neumann-Haefelin, Elke AU - Neumann-Haefelin E AD - Department of Medicine IV: Nephrology and Primary Care, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany. FAU - Biever, Paul Marc AU - Biever PM AD - Department of Medicine III: Interdisciplinary Medical Intensive Care, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany. AD - Department of Cardiology and Angiology I, Heart Center, University of Freiburg, Freiburg, Germany. FAU - Walz, Gerd AU - Walz G AD - Department of Medicine IV: Nephrology and Primary Care, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany. FAU - Kalbhenn, Johannes AU - Kalbhenn J AD - Department of Anesthesiology and Critical Care, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany. FAU - Tanriver, Yakup AU - Tanriver Y AUID- ORCID: 0000-0002-4806-2548 AD - Department of Medicine IV: Nephrology and Primary Care, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany. yakup.tanriver@uniklinik-freiburg.de. AD - Institute of Medical Microbiology and Hygiene, Faculty of Medicine, University of Freiburg, Freiburg, Germany. yakup.tanriver@uniklinik-freiburg.de. LA - eng GR - 2016_Kolleg.03/Else Kroner-Fresenius-Stiftung/International GR - 2017_EKES.34/Else Kroner-Fresenius-Stiftung/International GR - SFB 1160 (P06/ B08)/Deutsche Forschungsgemeinschaft/International PT - Comparative Study PT - Journal Article DEP - 20201116 PL - England TA - BMC Nephrol JT - BMC nephrology JID - 100967793 RN - 0 (Anticoagulants) RN - 0 (Heparin, Low-Molecular-Weight) RN - 0 (Pipecolic Acids) RN - 0 (Sulfonamides) RN - 2968PHW8QP (Citric Acid) RN - 9005-49-6 (Heparin) RN - 94ZLA3W45F (Arginine) RN - IY90U61Z3S (argatroban) SB - IM MH - Acute Kidney Injury/blood/epidemiology/*therapy MH - Adult MH - Aged MH - Anticoagulants/*administration & dosage MH - Arginine/analogs & derivatives MH - *Betacoronavirus MH - Blood Coagulation MH - COVID-19 MH - Citric Acid/administration & dosage MH - Comorbidity MH - Coronavirus Infections/blood/*epidemiology MH - Critical Care MH - Critical Illness MH - Equipment Failure MH - Female MH - Germany/epidemiology MH - Heparin/administration & dosage MH - Heparin, Low-Molecular-Weight/administration & dosage MH - Humans MH - Male MH - Middle Aged MH - Pandemics MH - Pipecolic Acids/administration & dosage MH - Pneumonia, Viral/blood/*epidemiology MH - Renal Replacement Therapy/instrumentation/*methods MH - Retrospective Studies MH - SARS-CoV-2 MH - Sulfonamides MH - Tertiary Care Centers PMC - PMC7668013 OTO - NOTNLM OT - Acute kidney injury OT - Anticoagulation OT - COVID-19 OT - Critical care OT - Emerging communicable diseases OT - Renal replacement therapy OT - SARS-CoV-2 COIS- Authors have nothing to disclose. EDAT- 2020/11/18 06:00 MHDA- 2020/11/26 06:00 PMCR- 2020/11/16 CRDT- 2020/11/17 05:42 PHST- 2020/08/16 00:00 [received] PHST- 2020/11/03 00:00 [accepted] PHST- 2020/11/17 05:42 [entrez] PHST- 2020/11/18 06:00 [pubmed] PHST- 2020/11/26 06:00 [medline] PHST- 2020/11/16 00:00 [pmc-release] AID - 10.1186/s12882-020-02150-8 [pii] AID - 2150 [pii] AID - 10.1186/s12882-020-02150-8 [doi] PST - epublish SO - BMC Nephrol. 2020 Nov 16;21(1):486. doi: 10.1186/s12882-020-02150-8.