Hemostasis disorders during extracorporeal detoxification and the possibility of their prevention. Literature review

Abstract

A significant proportion of surgical patients requiring extracorporeal detoxification (ECD) initially have various hemostasis disorders and associated risks. Extracorporeal treatment can lead to the progression of such pathological conditions, including the development of clinically significant bleeding. The work analyzes modern literature, covering the development of hemostasis disorders during ECD and the possibility of their prevention. Currently, there is no consensus on the most significant causes and mechanisms of coagulation disorders in ECD, often leading to serious bleeding and deterioration in patient outcomes. Researchers agree that a significant influence on the risk of occurrence of coagulopathy is not exerted by the severity of the underlying disease, but by the presence of coagulation disorders before treatment. In patients who initially had coagulopathy and/or thrombocytopenia, bleeding after ECD sessions is observed in 40–50 % of cases. The role of heparin anticoagulation in the development of hemorrhagic complications has not yet received a final assessment. In the majority of publications in the literature, the authors conclude that citrate anticoagulation is effective and safe in various types of extracorporeal detoxification, noting that the use of citrate instead of heparin allows not only significantly extending the life of the filter, but also reducing the risk of developing coagulopathy and bleeding after the procedure. Questions of use, risks, and benefits of citrate anticoagulation over heparin for ECD in surgical patients with coagulopathy require further study.