Association of blood coagulation and fibrinolysis onto circuit clotting in continuous renal replacement therapy

Abstract

We investigated the association between circuit clotting during continuous renal replacement therapy (CRRT) and blood coagulation-fibrinolysis system using fibrin monomer complex (FMC) and plasmin-α2-plasmin inhibitor complex (PIC). We retrospectively analyzed data of 53 patients who received CRRT between January 2016 and September 2023．Nafamostat mesilate was used as an anticoagulant. Patients were divided into two groups: the coagulation group, which included patients who required an unexpected exchange of CRRT circuit due to adverse coagulative events, and the non-coagulation group without circuit coagulation. Before CRRT initiation, FMC and PIC were significantly high in the coagulation group. Increase in FMC was independently significant by logistic analysis, and its cut-off value was 150μg/mL. In the non-coagulation group, FMC was positively correlated with PIC before CRRT initiation. In addition, the association between the changes in FMC and PIC as variations between data before CRRT and at day 2 after CRRT initiation showed that PIC was elevated in this group, which correlated with FMC levels. However, in the coagulation group, the change in PIC did not correlate with changes in FMC and plasminogen levels after CRRT initiation. Thus, we concluded that the coagulation group is in a hypercoagulable state before initiation of CRRT, and FMC ≧150μg/mL could be an indicator for circuit clotting. Furthermore, it is hypothesized that the coagulation and fibrinolysis systems would be interrupted, with the fibrinolysis system being suppressed in the coagulation group. Therefore, inhibition of anti-fibrinolytic pathway might be important for maintaining a non-clotting circulation in CRRT.