Successful application of low-dose regional citrate combined with nafamostat mixed anticoagulation in CRRT for patients with liver failure: a retrospective case series study of 11 patients
- 1Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University
- 2Hubei Clinical Research Center for Critical Care Medicine
Abstract
Objective: To investigate the clinical efficacy, safety and operational feasibility of a low-dose regional citrate anticoagulation (RCA) combined with low-dose nafamostat mesylate (NM) mixed anticoagulation regimen in continuous renal replacement therapy (CRRT) for patients with liver failure, so as to provide clinical reference for the selection of CRRT anticoagulation strategies for such special high-risk critically ill patients.
Method: A retrospective case series study was conducted. Eleven patients with liver failure who received CRRT in the Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University were enrolled. All patients were treated with CVVHDF mode and uniformly implemented the low-dose citrate combined with nafamostat mixed anticoagulation regimen. CRRT treatment parameters, anticoagulant drugs, and infusion doses of calcium and sodium bicarbonate were standardized. The monitoring frequency of peripheral blood gas and activated partial thromboplastin time (APTT) and the criteria for dose stratification adjustment were standardized. Data including patients' demographic baseline data, CRRT treatment duration, filter service life, blood gas electrolytes, dynamic changes of APTT, pipeline and filter coagulation, bleeding and metabolic adverse events, organ function and clinical outcomes were collected for summary and analysis.
Results: A total of 11 patients with liver failure undergoing CRRT in CVVHDF mode were enrolled in this study, using the low-dose regional citrate combined with nafamostat mixed anticoagulation regimen. After treatment, the median filter life of patients reached 48 (38, 68.75) hours, with no severe pipeline or filter coagulation; there were no significant abnormalities in systemic coagulation indicators. One case (9.1%) had mild oral mucosal bleeding; no severe massive bleeding occurred. Hypocalcemia and metabolic alkalosis were observed in several patients but were not severe, and no citrate accumulation, severe hypocalcemia, or severe acid-base or electrolyte disorders occurred. PCT was lower than baseline (P = 0.005) and APACHE II score was improved (P = 0.011) over the course of ICU treatment; however, all patients simultaneously received antibiotics, vasopressors, source control, and other ICU supportive care, and these changes therefore cannot be attributed to the mixed anticoagulation regimen. Liver and kidney function showed no obvious deterioration.
Conclusion: In this small, single-center retrospective case series, a low-dose regional citrate combined with nafamostat mixed anticoagulation regimen was feasible to implement in patients with liver failure receiving CRRT. In this cohort, the median filter life was 48 h, no severe filter or pipeline coagulation was observed, and no citrate accumulation, severe hypocalcemia, or severe acid-base or electrolyte disorders occurred; one case (9.1%) had mild bleeding. Because no comparator group was included, whether these observations reflect a benefit of the mixed regimen over conventional RCA, nafamostat alone, systemic heparin, or no anticoagulation cannot be determined. These findings are preliminary and hypothesis-generating and require confirmation in adequately powered, multicenter, prospective controlled trials.
Related
- Comparison between regional citrate anticoagulation and systemic heparin anticoagulation in patients undergoing continuous renal replacement therapy and venoarterial extracorporeal membrane oxygenation: A retrospective multicentric study
- Efficacy and safety of nafamostat mesilate for anticoagulation during ECMO/CRRT: insight from the integrated meta-analysis and FAERS pharmacovigilance study
- Expanding the Donor Pool in Pediatric Transplantations: Successful Domino Liver Transplantation From the Youngest Reported Pediatric DCD Donor Using Normothermic Regional Perfusion in the United States
- PO122 | SUCCESSFUL MANAGEMENT OF THERAPEUTIC ANTICOAGULATION FOR PROVOKED VENOUS THROMBOEMBOLISM IN A PATIENT WITH FACTOR VII DEFICIENCY AND SEPTIC SHOCK
- Early recurrent hemofilter thrombosis despite regional citrate anticoagulation during continuous renal replacement therapy: a prospective observational study
BibTeX
@article{zhang2026successful,
title = {{Successful application of low-dose regional citrate combined with nafamostat mixed anticoagulation in CRRT for patients with liver failure: a retrospective case series study of 11 patients}},
author = {Yanting Zhang and Jing Ma and Le Xiao and Jian Ye and Hanqing Li and Zhaoyang Li and Meng Xiao and Xinbo Ding and Pu Zhang},
journal = {Frontiers in Pharmacology},
year = {2026},
month = oct,
doi = {10.3389/fphar.2026.1896125},
url = {https://www.frontiersin.org/articles/10.3389/fphar.2026.1896125/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Successful application of low-dose regional citrate combined with nafamostat mixed anticoagulation in CRRT for patients with liver failure: a retrospective case series study of 11 patients
AU - Yanting Zhang
AU - Jing Ma
AU - Le Xiao
AU - Jian Ye
AU - Hanqing Li
AU - Zhaoyang Li
AU - Meng Xiao
AU - Xinbo Ding
AU - Pu Zhang
PY - 2026
DA - 2026/10/21
JO - Frontiers in Pharmacology
DO - 10.3389/fphar.2026.1896125
UR - https://www.frontiersin.org/articles/10.3389/fphar.2026.1896125/full
AB - Objective: To investigate the clinical efficacy, safety and operational feasibility of a low-dose regional citrate anticoagulation (RCA) combined with low-dose nafamostat mesylate (NM) mixed anticoagulation regimen in continuous renal replacement therapy (CRRT) for patients with liver failure, so as to provide clinical reference for the selection of CRRT anticoagulation strategies for such special high-risk critically ill patients. Method: A retrospective case series study was conducted. Eleven patients with liver failure who received CRRT in the Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University were enrolled. All patients were treated with CVVHDF mode and uniformly implemented the low-dose citrate combined with nafamostat mixed anticoagulation regimen. CRRT treatment parameters, anticoagulant drugs, and infusion doses of calcium and sodium bicarbonate were standardized. The monitoring frequency of peripheral blood gas and activated partial thromboplastin time (APTT) and the criteria for dose stratification adjustment were standardized. Data including patients' demographic baseline data, CRRT treatment duration, filter service life, blood gas electrolytes, dynamic changes of APTT, pipeline and filter coagulation, bleeding and metabolic adverse events, organ function and clinical outcomes were collected for summary and analysis. Results: A total of 11 patients with liver failure undergoing CRRT in CVVHDF mode were enrolled in this study, using the low-dose regional citrate combined with nafamostat mixed anticoagulation regimen. After treatment, the median filter life of patients reached 48 (38, 68.75) hours, with no severe pipeline or filter coagulation; there were no significant abnormalities in systemic coagulation indicators. One case (9.1%) had mild oral mucosal bleeding; no severe massive bleeding occurred. Hypocalcemia and metabolic alkalosis were observed in several patients but were not severe, and no citrate accumulation, severe hypocalcemia, or severe acid-base or electrolyte disorders occurred. PCT was lower than baseline (P = 0.005) and APACHE II score was improved (P = 0.011) over the course of ICU treatment; however, all patients simultaneously received antibiotics, vasopressors, source control, and other ICU supportive care, and these changes therefore cannot be attributed to the mixed anticoagulation regimen. Liver and kidney function showed no obvious deterioration. Conclusion: In this small, single-center retrospective case series, a low-dose regional citrate combined with nafamostat mixed anticoagulation regimen was feasible to implement in patients with liver failure receiving CRRT. In this cohort, the median filter life was 48 h, no severe filter or pipeline coagulation was observed, and no citrate accumulation, severe hypocalcemia, or severe acid-base or electrolyte disorders occurred; one case (9.1%) had mild bleeding. Because no comparator group was included, whether these observations reflect a benefit of the mixed regimen over conventional RCA, nafamostat alone, systemic heparin, or no anticoagulation cannot be determined. These findings are preliminary and hypothesis-generating and require confirmation in adequately powered, multicenter, prospective controlled trials.
SN - 1663-9812
ER -