Heparin-coated polyacrylonitrile membrane versus regional citrate anticoagulation: a prospective randomized study of 2 anticoagulation strategies in patients at risk of bleeding.

Background Hemodialysis requires anticoagulationto prevent clotting of the extracorporeal circuit. Systemic anticoagulationwith heparin is contraindicated in patients at high risk of bleeding. In these patients, regional citrate anticoagulation(RCA), with either calcium-free (RCA-Ca0) or calcium-containing dialysate (RCA-Ca3.0), and heparin-coated membranes (1.3 m 2 ; AN69ST; Nephral 300ST, Gambro-Hospal, Meyzieu, France) may represent valid alternatives. Methods To compare the efficacy and safety of these regional anticoagulationmodalities, we performed a prospective randomized trial including 33 hemodialysis patients at high risk of bleeding. Regional anticoagulationwas achieved by means of either AN69ST (11 patients, 31 sessions), RCA-Ca0 (11 patients, 32 sessions), or RCA-Ca3.0 (11 patients, 30 sessions). Patients assigned to RCA were dialyzed using a polysulfonemembrane (1.3 m 2 ; F60; Fresenius Medical Care, Bad Homburg, Germany). Scheduled dialysis time was 4 hours. At the end of each dialysis session, the dialyzer was inspected for visible signs of thrombus formation and scored semiquantitatively (0, no clotting, to 4, severe clotting). Solute clearances were monitored at the second and fourth treatment hour as a parameter of subclinical clotting of the dialyzer. Results Clotting phenomena necessitating premature termination of the dialysis session were encountered in 39%, 13%, and 0% using AN69ST, RCA-Ca3.0, and RCA-Ca0, respectively ( P P Conclusion Citrate provides superior regional anticoagulationcompared with AN69ST membranes.