Abstract: 【Abstract】Objective To compare the three anticoagulant methods, regional citrate anticoagulation (RCA), unfractionated heparin (UFH) anticoagulation and low molecular weight heparin (LMWH) anticoagulation, in hemoperfusion therapy for severe poisoning patients, and to assess the efficacy and safety of RCA in hemoperfusion therapy. Methods Thirty severe poisoning patients treated with hemoperfusion therapy from Jan. 2014 to Sept. 2017 were randomly divided into RCA group (n=10), UFH group (n=10) and LMWH group (n=10). Blood coagulation, bleeding, blood platelet count (BPC), activated partial thromboplastin time (APTT), prothrombin time (PT) and fibrinogen (Fib) were compared between the 3 groups. Serum ionized Ca+2, total calcium and blood pH were compared before and after hemoperfusion in RCA group. Results Blood coagulation in perfusion apparatus was not found in RCA group, but occurred in 2 cases in UFH group and in one case with level III blood clotting in LMWH group. There was no bleeding at puncture site in RCA group. In IFH group, bleeding happened in 3 cases at puncture site, 3 cases in subcutaneous tissues and 2 cases at other sites (χ2=9.436, P=0.022, as compared with that in RCA group). In LMWH group, bleeding was found in 3 cases at puncture site, 2 cases in subcutaneous tissues and one case at other sites (χ2=8.556, P=0.036, as compared with that in RCA group). After hemoperfusion therapy, Fib and BPC decreased in the 3 groups; APTT, PT, BPC, and Fib changed more in UFH group than in RCA group (t=2.722, P=0.009 for APTT; t=2.234, P=0.016 for PT; t=3.893, P=0.001 for BPC; t=4.056, P＜0.001 for Fib) and more in LMWH group than in RCA group (t=2.459, P=0.012 for APTT; t=2.168, P=0.021 for PT; t=3.608, P=0.001 for BPC; t=3.892, P=0.001 for Fib). Serum ionized Ca + 2, total calcium, blood pH changed insignificantly in RCA group (t=0.452, P=0.594 for serum ionized Ca + 2; t=0.307, P=0.681 for serum total calcium; t=0.260, P=0.758 for blood pH). Conclusion RCA was better than UFH and LMWH in anticoagulation effect, lower incidence of bleeding and safety for use. Thus RCA is suitable for routine use in hemoperfusion therapy.

Key words: regional citrate anticoagulation , Hemoperfusion, Anticoagulation, poisoning