[Comparison of the antithrombotic effects of heparin, enoxaparin and prostacycline in continuous hemofiltration].
Continuous anticoagulation is required during haemofiltration to prevent the deposition of fibrin and the formation of thrombus which would lead to early clotting of the haemofilter. This study aimed to compare the efficiencies of 3 different anticoagulation protocol: 150 IU.kg-1.day-1 heparin (group HEP), 1.2 mg.kg-1.day-1 enoxaparin (group ENX), and a combination of 0.8 mg.kg-1.day-1 enoxaparin with 5 ng.kg-1.min-1 prostaglandin I2 (group ENX and PGI2). A flat ANS69S (Hospal) haemofilter was used for continuous venovenous haemofiltration. Antithrombotic efficiency was assessed with a haemofilter permeability index (HPI) including the transmembraneous pressure gradient and the rate of production of ultrafiltrate. The time required for HPI to decrease to 1/3 of its initial value (HPI1/3) was used to compare the 3 protocols. Treatment tolerance was judged by monitoring the usual haemodynamic and haemostatic parameters. No adverse effects (bleeding, thrombosis, hypotension) were observed. HPI1/3 was 15.1 +/- 2.4 h, 18.3 +/- 3.1 h and 28.2 +/- 4.2 h in groups HEP, ENX and ENX and PGI2 respectively. High dose enoxaparin reached antithrombotic efficiency without increasing the risk of haemorrhage. The use of low doses of prostaglandin I2 greatly increased HPI1/3, without any deleterious haemodynamic effects. However, the high cost of prostaglandin I2 needs to be put in the balance with the increase in duration of haemofilter life. Therefore, further investigations are required to evaluate the possible synergy between heparin and prostaglandin I2, as well as the biological parameters which need to be monitored.
Journois
D
D
Département d'Anesthésie-Réanimation, Hôpital Laënnec, Paris.
Safran
D
D
Castelain
M H
MH
Chanu
D
D
Drévillon
C
C
Barrier
G
G
D058186:Acute Kidney Injury / Q000628:therapy; D000368:Aged; D001780:Blood Coagulation Tests; D002985:Clinical Protocols; D004359:Drug Therapy, Combination; D011464:Epoprostenol / Q000494:pharmacology*; D005260:Female; D006400:Hematocrit; D006439:Hemodynamics; D006440:Hemofiltration / Q000379:methods*; D006493:Heparin / Q000494:pharmacology*; D006495:Heparin, Low-Molecular-Weight / Q000494:pharmacology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D013927:Thrombosis / Q000517:prevention & control*
D006495:Heparin, Low-Molecular-Weight; D006493:Heparin; D011464:Epoprostenol
Comparaison des effets antithrombotiques de l'héparine, l'énoxaparine et la prostacycline au cours de l'hémofiltration continue.