Regional citrate anticoagulation vs systemic heparin anticoagulation for double‐filtration plasmapheresis

• Published in: Journal of clinical apheresis Vol. 38; no. 1; pp. 16 - 23
• Main Authors: Teh, Swee Ping, Ho, Quan Yao, Kee, Yi Shern Terence, Thangaraju, Sobhana, Tan, Ru Yu, Teo, Su Hooi, Tan, Han Khim, Tan, Chieh Suai, Choong, Hui Lin Lina, Ng, Li Choo, Abdul Rahman, Maslinna, Lim, Amy Ee Lin, Kaushik, Manish
• Format: Journal Article
• Language: English
• Published: Hoboken, USA John Wiley & Sons, Inc 01.02.2023; Wiley Subscription Services, Inc
• Subjects: Anticoagulants; Anticoagulants - therapeutic use; anticoagulation; Apheresis; Catheters; Citrates; Citric Acid - therapeutic use; double‐filtration plasmapheresis (DFPP); Heparin - therapeutic use; Humans; Kidney transplants; Plasmapheresis; regional citrate anticoagulation; Retrospective Studies; systemic heparin anticoagulation; double-filtration plasmapheresis (DFPP); regional citrate anticoagulation; systemic heparin anticoagulation; anticoagulation
• ISSN: 0733-2459; 1098-1101; 1098-1101
• DOI: 10.1002/jca.22019

Introduction Double‐filtration plasmapheresis (DFPP) has been utilized for immunomodulation in kidney transplantation. Anticoagulation is important to maintain circuit patency during DFPP. We aimed to compare the efficacy and safety of regional citrate anticoagulation (RCA) with systemic heparin anticoagulation during DFPP in kidney transplant recipients. Methods A retrospective cohort study was conducted to compare the efficacy and safety of RCA (RCA‐DFPP) to systemic heparin anticoagulation (Hep‐DFPP) for DFPP among kidney transplant recipients in a single tertiary center. Results A total of 112 sessions of DFPP were performed for 23 subjects, of which 62 sessions were RCA‐DFPP and 50 sessions were Hep‐DFPP. There were 13 sessions (11.6%) of premature circuit clotting, 10 sessions (16.1%) for RCA‐DFPP and 3 sessions (6.0%) for Hep‐DFPP (P = .10). All premature circuit clotting episodes occurred in subjects who underwent DFPP through a vascular catheter. Premature circuit clotting was associated with the use of a vascular catheter (odds ratio [OR] 14.2, 95% confidence interval [CI] 2.7‐73.7; P < .01) and high postfilter ionized calcium (OR 12.7, 95% CI 1.4‐112.5; P < .01). There was no major bleeding event. Hep‐DFPP was associated with higher occurrence of hypocalcemia (OR 1.1, 95% CI 1.0‐1.2; P < .01) and metabolic acidosis (OR 1.4, 95% CI 1.2‐2.0; P = .04), while hypomagnesemia was more common for RCA‐DFPP (OR 2.9, 95% CI 1.1‐7.4; P = .03). Conclusion Amongst kidney transplant patients who receive DFPP therapy, RCA‐DFPP may be comparable to Hep‐DFPP for the maintenance of circuit patency. Functioning vascular access is vital in avoiding premature clotting of the circuit. Close monitoring of electrolyte imbalances and coagulopathy related to DFPP is recommended.