Comparison between regional citrate anticoagulation and systemic heparin anticoagulation in patients undergoing continuous renal replacement therapy and venoarterial extracorporeal membrane oxygenation: A retrospective multicentric study

doi:10.1016/j.aicoj.2025.100013

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Comparison between regional citrate anticoagulation and systemic heparin anticoagulation in patients undergoing continuous renal replacement therapy and venoarterial extracorporeal membrane oxygenation: A retrospective multicentric study

Ann Intensive CarePublished 16 Jan 2026Retrospective cohort study

Main finding · CRRT filter thrombosisResultAdjusted hazard ratio 0.35 95% CI 0.21–0.59

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Authors' conclusion

In patients receiving VA-ECMO and CRRT, RCA was safe and effective. RCA was associated with a significantly lower risk of filter thrombosis, despite similar median filter lifespan, without increasing bleeding or severe metabolic complications.

Study context

Population: Adults receiving simultaneous venoarterial extracorporeal membrane oxygenation (VA-ECMO) and continuous renal replacement therapy (CRRT) in four French ICUs, January 2019–December 2021
Participants: 599 CRRT sessions

Exposure: Regional citrate anticoagulation vs unfractionated heparin for CRRT
Regional citrate anticoagulation (RCA)n = 106
Unfractionated heparin (UFH)n = 493reference
Outcome: CRRT filter thrombosis (unplanned circuit cessation due to clotting)

Methodological detailsmulticentric, Fine-Gray competing-risk regression, multiple imputation

Multicentric
Fine-Gray competing-risk regression
Multiple imputation

Main finding

CRRT filter thrombosis

Adjusted hazard ratio

0.35

95% CI 0.21–0.59

P < 0.001

By group

RCA17.0%estimated cumulative incidence at 72 h · 95% CI 10.5–24.8%

UFH26.6%estimated cumulative incidence at 72 h · 95% CI 22.8–30.5%

RCA vs UFH

aHR 0.35 (95% CI 0.21–0.59); P < 0.001

As reported in the abstract

Observational data: associations, not effects.

Secondary outcomes

Filter lifespan · did not differ significantly

P = 0.144

RCAmedian 47 hoursIQR 21–90

UFHmedian 44 hoursIQR 20–72

Safety

Bleeding events

P = 0.417

RCA33.3%

UFH37.6%

Severe metabolic complications

RCA did not increase the incidence of severe metabolic complications

Original publication

Comparison between regional citrate anticoagulation and systemic heparin anticoagulation in patients undergoing continuous renal replacement therapy and venoarterial extracorporeal membrane oxygenation: A retrospective multicentric study. Ann Intensive Care. Published 16 January 2026. doi:10.1016/j.aicoj.2025.100013

Read the original article ↗

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