Effect of regional citrate anticoagulation vs. low molecular weight heparin anticoagulation in continuous renal replacement therapy for critically ill patients: A retrospective cohort study

Abstract Introduction This study aimed to assess the efficacy and safety of regional citrate anticoagulation (RCA) and low molecular weight heparin anticoagulation (LMHA) in critically ill patients undergoing continuous renal replacement therapy (CRRT). Methods The clinical data of patients who underwent CRRT at Inner Mongolia People's Hospital from January 2022 to March 2024 were collected. Patients were divided into the RCA group and the LMHA group. The primary outcomes were filter survival time and 28‐day mortality. The secondary outcomes were adverse events of CRRT anticoagulation. Results The filter lifespan of the RCA group was significantly extended (33.5 vs. 27.5 h, p ≤ 0.001), and the occurrence of filter coagulation events in the RCA group was markedly reduced (7.0% vs. 21.1%, p = 0.03). There were no statistically significant differences in bleeding and electrolyte disturbances between the two groups. The multivariate COX regression analysis demonstrated that the anticoagulation strategy was the singular factor influencing filter survival time (hazard ratio [HR] = 4.74, 95% CI 1.67–13.50, p = 0.004). Conclusions RCA demonstrated significantly prolonged filter lifespan and reduced instances of filter clotting compared to LMHA. RCA represents a safe and effective anticoagulation strategy for CRRT.