Ptns commencing CRRT are commonly receiving an anticoagulant to avoid thrombosis of the DX filter;
Zarbock A, Küllmar M, Kindgen-Milles D, et al. Effect of Regional Citrate Anticoagulation vs Systemic Heparin Anticoagulation During Continuous Kidney Replacement Therapy on Dialysis Filter Life Span and Mortality Among Critically Ill Patients with Acute Kidney Injury: A Randomized Clinical Trial. JAMA 2020; 324:1629.
If the dialyzer hemofilter cannot be kept with no anticoagulation for minimally 24 hs, anticoagulation can be addressed unless the clotting was related to access malfunction. If RCA is available and the RCA was not contraindicated, we can admit RCA module rather than UFH. RCA is efficacious with an increased hemofilter lifespan and low risk of bleeding and transfusion facilities as compared to the UFH. For ptns having CI or cannot tolerate RCA, or if RCA is not feasible, UFH can be permitted.