Regional Citrate Anticoagulation

Anticoagulation by regional citrate is based on the concept of inhibition of clotting by chelation of ionized calcium, and it was first developed as an alternative anticoagulant regimen in HD patients at risk of bleeding (Pinnick et al., 1983). Metabolic alkalosis, hypernatremia, alterations in calcium homeostasis, and hyperalbuminemia are reported side effects that are generally manageable (Ward and Mehta, 1993; Flanigan et al., 1996; Janssen et al., 1996). Regional citrate anticoagulation is a valuable approach in experienced centers. Efficient and safe long-term citrate anticoagulation in a HIT patient over a period of 9 mo was reported (Unver et al., 2002). Regional citrate anticoagulation is a treatment option only in patients with a history of HIT as it does not suppress the prothrombotic state in acute HIT.

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