Safety and efficacy of citrate anticoagulation continuous post-cardiac surgery patients with liver dysfunction

Pei Feng-bo; Gong Li; Chen Zu-jun; Yang Qiu-lan; Liu Hong; Yao Yao; Shi Ye; Du Juan; Zhang Hai-tao; Wu Hui

doi:10.3969/j.issn.1002-1949.2018.03.009

Abstract：Objective To evaluate the safety and efficacy of citrate anticoagulant continuous post-cardiac surgery patients with liver dysfunction. Methods The data of post-cardiac surgery patients were analyzed retrospectively in Fuwai Hospital from February 2012 to October 2017. Liver dysfunction was defined as Child-Turcotte-Pugh (CTP) score ＞ 4. A total of 102 patients met the criteria. The patients were divided into citrate group, heparin group and no anticoagulant group according to their different anticoagulant methods. Results There was no statistical difference between the three groups at baseline. The pH value, BE,lactic acid and serum calcium concentration were not statistically different 6 hours after renal replacement therapies. The total calcium in the citrate group was higher(P-0.025). In the heparin group, the pleural drainage was (819 ±314)mL during the blood filtration treatment, compared with (477±268) mL and (414 ± 335) mL in the citrate and non anticoagulant groups. There was significant difference between the heparin anticoagulant group and the citrate group and the anticoagulant group (P = 0.027 and P=0.021 ). The citrate group filter life was (54.050 ±2.744) h, heparin group was (49.110 ± 1.462) h, no anticoagulant group (25.690 ±2.577 ) h, the difference between the three groups was statistically significant (Log-rank test, χ2= 44.11, P ＜0.001 ). Conclusion Citrate anticoagulation can increase the life of filter in patients with liver dysfunction after cardiac surgery,without increasing the amount of bleeding after operation or causing internal environmental imbalance and electrolyte disturbance.