Treatment is possible with both heparin and citrate. If CytoSorb is used as a stand-alone therapy, only heparin may be used for anticoagulation. Citrate is contraindicated in this setup.
In general, no special protocol adjustments are required for CytoSorb. The instructions by the device manufacturer must be followed.
In case of systemic anticoagulation with heparin the following applies:
As a matter of principle, anticoagulation must be effective before starting treatment. This means to first increase the aPTT to the target value and only then start the extracorporeal procedure.
Recommended target values when using heparin:
- aPTT: 60–80 sec (activated partial thromboplastin time. This value corresponds to 2–3 times the baseline value).
- ACT: 160–210 sec (activated clotting time standard value 100-130 sec)
- AT III: 75–120% (antithrombin III)
- Caution: HIT (heparin-induced thrombocytopenia).
These target values are controlled according to the respective standards of the critical care unit. The decision regarding dosage and target values is always the responsibility of the attending physician.
For regional anticoagulation with citrate, the following applies:
- Initial dose, blood flow rate, control and adjustment of calcium and citrate is according to protocol.
- Citrate and calcium are to be added at the usual points of the extracorporeal circulation.
- Control of ionized calcium (CRRT circuit and patient) a few minutes after the start of treatment and at regular intervals of 8 – 12 hours is recommended.
The decision regarding dosage and target levels is always the responsibility of the treating physician.