Methods of extracorporeal detoxification in the treatment of patients with acute necrotic pancreatitis and DIC

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.

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

Shalaeva¹,

Golubeva²,

Misikov³

2023

Surgeon

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Alternative anticoagulation during extracorporeal detoxification

Rodoman,

Shalaeva,

Golubeva

et al. 2023

Surgeon

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The role of heparin anticoagulation in the development of hemorrhagic syndrome after extracorporeal detoxification (ECD) procedures in patients with initial hemostasis disorders, as well as the place of alternative citrate anticoagulation in extracorporeal treatment have not yet received a final assessment and require further study. The aim of this work was to compare the results of treatment of patients with severe intoxication using heparin and citrate as anticoagulants during ECD procedures. The conducted study confirms that the use of heparin anticoagulation in ECD leads to a spasmodic progression of the manifestations of DIC that were present before the procedure. Citrate anticoagulation demonstrates the benefits consisting in the absence of a spasmodic increase in coagulopathy, hypofibrinemia, and thrombocytopenia during an ECD session, which is characteristic of the heparin use. However, when ECD is initiated against the background of more severe initial coagulopathy and, interrelatedly, more severe multiple organ failure (MOF), this does not improve treatment outcomes. Moreover, among patients with severe MOF taken for ECD, there was a greater mortality rate and a large proportion of deaths during and immediately after the session when using citrate anticoagulation. Thus, ECD procedures with citrate anticoagulation may have a negative impact on the condition of patients who already have severe MOF and severe coagulopathy. This risk may be associated with metabolic disorders, especially dangerous in such severe patients, and does not outweigh the risk of an increase in hemostasis disorders characteristic of heparin anticoagulation. Probably, ECD with citrate anticoagulation has to be carried out at an earlier stage of the disease, and in cases of severe MOF already present in the patient, it is advisable to use traditional heparin anticoagulation.

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Methods of extracorporeal detoxification in the treatment of patients with acute necrotic pancreatitis and DIC

Cited by 2 publications

References 8 publications

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

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

Alternative anticoagulation during extracorporeal detoxification

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