From Madan Verma: Hi George. I am wondering if there are any correlation studies about whether switching hemodialysis patients from heparin to 4% sodium citrate will affect the prothrombin time (PT) or partial thromboplastin time (PTT). Thank you.
Hello, Madan Verma, and thank you for your patience. I found over 500 PubMed references, most of which confirm that citrate anticoagulation in dialysis confers a lower risk of bleeding than heparin. One example is Morabito S, Pistolesi V, Tritapepe L, et al. Regional citrate anticoagulation in cardiac surgery patients at high risk of bleeding: a continuous veno-venous hemofiltration protocol with a low concentration citrate solution. Crit Care. 2012;16):R111. While heparin prolongs the PTT, no reference indicates an effect of citrate on routine coagulation screening assays. I also checked with Jill Adamski, MD, pathologist at University of Alabama at Birmingham Hospital who reminded me that we routinely use citrate for anticoagulation during pheresis. I should have realized myself as a regular platelet donor. Once the “citrate buzz” goes away, there is no lasting effect on any plasma parameters. So I conclude that citrate used in dialysis will have no effect on the PT or PTT.