Table 3. Anticoagulation Management During CKRT.
| Characteristic | Responses, No. (%) |
|---|---|
| First-line anticoagulation of choice | |
| No. | 133 |
| Regional unfractionated heparin infusion | 54 (41) |
| Citrate-based regional anticoagulation | 47 (35) |
| Regional heparin and protamine anticoagulation | 15 (11) |
| Systemic unfractionated heparin infusion | 10 (8) |
| Systemic LMWH | 5 (4) |
| Regional prostacyclin | 1 (1) |
| Otherb | 1 (1) |
| Second-line anticoagulation of choice | |
| No. | 131 |
| Citrate-based regional anticoagulation | 45 (34) |
| Regional unfractionated heparin | 28 (21) |
| Systemic unfractionated heparin infusion | 17 (13) |
| No anticoagulation | 10 (8) |
| Systemic LMWH | 10 (8) |
| Regional heparin and protamine anticoagulation | 9 (7) |
| Regional prostacyclin | 9 (7) |
| Systemic prostacyclin | 1 (1) |
| Otherc | 1 (1) |
| Preferred test to measure heparin anticoagulationa | |
| ACT | 84 (53) |
| aPTT | 82 (51) |
| Anti–Xa levels | 38 (24) |
| No monitoring | 2 (1) |
| What is considered an adequate filter life in patients undergoing CKRT? | |
| No. | 132 |
| 72 h | 19 (14) |
| 48-72 h | 82 (62) |
| 24-48 h | 25 (19) |
| ≤24 h | 6 (5) |
| When is the filter routinely changed (according to manufacturer recommendations) if there are no issues? | |
| No. | 130 |
| Every 72 h | 80 (62) |
| Every 48 h | 13 (10) |
| Every 24 h | 8 (6) |
| We do not follow manufacturer recommendations | 29 (22) |
| What situation triggers the change of the filter? | |
| No. | 132 |
| Filter clotting | 70 (53) |
| Increase of transmembrane pressure | 62 (47) |
| Most common complications using anticoagulation during CKRT | |
| No. | 91 |
| Catheter and/or circuit thrombosis | 27 (30) |
| Bleeding | 22 (24) |
| Catheter site and/or mucosal bleeding | 15 (17) |
| Citrate overload | 12 (13) |
| Thrombocytopenia | 9 (10) |
| Difficulty achieving adequate anticoagulation | 6 (7) |
Abbreviations: ACT, activated clotting time; aPTT, activated partial thromboplastin time; CKRT, continuous kidney replacement therapy; KRT, kidney replacement therapy; LMWH, low-molecular-weight heparin.
a
The sum of percentages is more than 100% because respondents could indicate more than one option.
b
Regional heparin without protamine.
c
Direct thrombin inhibitors or no answer.