For a study, researchers sought to understand how RCA affected thrombin production, fibrinolysis, and platelet function in critically sick patients receiving continuous renal replacement therapy (CRRT), compare clotting parameters between systemic and intra-circuit blood samples, and screen participants for coagulation problems. Investigators enrolled critically sick adult patients who needed CRRT with RCA for acute kidney injury (AKI) and were hospitalized in a 30-bed Intensive Care Unit in a tertiary care institution. Patients having thrombotic or bleeding tendencies or a CRRT duration of fewer than 48 hours were excluded from the study. At the start of the study, the study group assessed coagulation and thrombophilia parameters. Blood samples from the arterial line and the circuit were used to test thrombin production, D-dimer, and platelet function before and after CRRT at 12, 24, 36, 48, and 72 hours. All 11 patients (mean age 62.4 years, 82% male) had Factor VIII and von Willebrand Factor concentrations above the reference range at the start of the study and significantly enhanced peak thrombin production. Systemic maximum peak thrombin generation, delay to peak thrombin generation, fibrinogen, D-dimer, and platelet function analysis did not alter significantly during CRRT. The paired samples collected from the patient’s arterial line and the circuit revealed no significant difference. Patients who were critically unwell and required CRRT were hypercoagulable. Anticoagulation with citrate during CRRT did not affect thrombin production, D-dimer, or platelet function. The intra-circuit results were reflected in systemic clotting parameters.

Source:annalsofintensivecare.springeropen.com/articles/10.1186/s13613-022-01004-w