ORIGINAL RESEARCH article
Front. Pediatr.
Sec. Pediatric Critical Care
Volume 13 - 2025 | doi: 10.3389/fped.2025.1667760
Comparison of Different Anticoagulation Methods in Continuous Renal Replacement Therapy for Pediatric Acute Liver Failure patients: A Retrospective Observational Study
Provisionally accepted- 1Hunan Children's Hospital, Changsha, China
- 2Pediatric Intensive Care Unit, Hunan Children's Hospital, Changsha, China
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Objective: Optimal anticoagulation for pediatric acute liver failure (ALF) patients requiring continuous renal replacement therapy (CRRT) remains challenging due to concurrent bleeding risk and hypercoagulability. This study aimed to evaluate the efficacy and safety of various anticoagulation strategies in pediatric ALF. Methods: We retrospectively analyzed 51 children with ALF from January 2017 to December 2023. Patients were grouped based on anticoagulant: systemic heparin anticoagulation group (SHA group, n=19), regional citrate anticoagulation group (RCA group, n=15), and nafamostat mesylate group (NM group, n=17). Primary outcomes were filter lifespan and the incidence of new clinical bleeding episodes. Results: Filter lifespan was shortest in the SHA group but similar between the RCA and NM groups (SHA: 37.0 [34.0, 42.0] h; RCA: 43.0 [39.0, 49.0] h; NM: 43.0 [40.5, 48.0] h; P = 0.003). The SHA group experienced a significantly higher rate of new bleeding episodes (36.8%) compared with the RCA (6.7%) and NM (5.9%) groups (P = 0.036). Metabolic alkalosis and hypocalcemia were more frequent in the RCA group (46.7% vs. 10.5% vs. 11.8%; P < 0.001). Multivariate Cox regression showed that, relative to SHA, both RCA and NM significantly reduced filter clotting risk (HR = 0.537, 95% CI 0.332-0.868, P = 0.011). Additionally, higher pre-CRRT platelet count (HR = 1.014, 95% CI 1.007-1.021, P < 0.001), and higher initial transmembrane pressure (HR = 1.168, 95% CI 1.104 -1.236, P < 0.001) were associated with increased clotting risk. Conclusion: In ALF children undergoing CRRT, both RCA and NM demonstrate superior filter longevity and bleeding safety compared to heparin. NM may be preferred due to fewer metabolic disturbances than RCA.
Keywords: acute liver failure, continuous renal replacement therapy, Children, Anticoagulant, Heparin, regional citrate anticoagulation, Nafamostat mesylate
Received: 17 Jul 2025; Accepted: 14 Aug 2025.
Copyright: © 2025 He and Zhang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Xinping Zhang, Pediatric Intensive Care Unit, Hunan Children's Hospital, Changsha, China
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