Table 1.
Summary of anticoagulation methods in liver failure
| Method | Advantages | Disadvantages | Comments |
|---|---|---|---|
| No anticoagulation | No risk | Limited efficacy in preventing filter clotting | |
| Pre-dilution | No risk | Decrease solute clearance | |
| Saline flushes | No risk | Limited efficacy in preventing filter clotting | |
| Citrate | No systemic anticoagulation | Risk of citrate accumulation with hypocalcaemia and metabolic acidosis | Close monitoring of citrate accumulation with total to ionized calcium ratio; monitor serum and ionized calcium 2 h after a modification of calcium or citrate administration and every 4 h if stable |
| Unfractionated heparin | Anticoagulation effect easily monitored with aPTT; complete reversal with protamine | Limited data on its safety in liver failure | Use only if needed by another indication and target aPTT 1–1.4 × baseline if possible; monitor aPTT every 6 h; close monitoring of bleeding |
| Heparin–protamine | Limited data on safety and efficacy | ||
| Low-molecular-weight heparin | Increased risk of bleeding in AKI; incomplete reversal with protamine; no data in AKI and liver failure | Should be avoided until further data available; if used, close monitoring with anti-Xa is recommended (target 0.25– 0.35 IU/ml and monitor daily) | |
| Prostacyclin | Limited data on efficacy and safety | ||
| Nafamostat mesilate | Limited data on efficacy and safety |