title: A prospective study of thromboelastography (TEG) and filter life during continuous veno-venous hemofiltration.
abstract: Anticoagulants are commonly used to prolong circuit life during continuous hemofiltration. However, a clear correlation between routinely performed blood coagulability tests and circuit life has not been demonstrated. This lack of correlation may derive from the limited ability of such tests to describe the likelihood of in vivo clotting. We hypothesized that thromboelastography (TEG), which derives its variables from a closer reproduction of in vivo coagulation, would significantly correlate with filter life. Accordingly, we conducted a prospective pilot study of the correlation between filter life and TEG-derived variables in 21 hemofilters used in 6 critically ill patients admitted to a tertiary intensive care unit. It involved the performance of TEG during steady state anticoagulation, measurement of circuit life, and of routine coagulation variables. The results showed that the mean circuit life was 20.7+/-4.0 h despite an average aPTT of 67.7+/-12.8 s and a mean heparin dose of 472.5+/-96.2 IU/h. The mean INR was 1.4+/-1 and the mean platelet count was 118+/-16 x 10(3)/mm3. Although several TEG variables correlated with heparin dose (p < 0.03), no correlation was found between any of the routine coagulation variables or any of the TEG variables and circuit life. In conclusion, no significant correlation between TEG derived variables or routinely measured coagulation variables and circuit life could be demonstrated. These findings suggest that such tests are not useful indicators of circuit anticoagulation adequacy and that factors other than blood coagulability may play a role in circuit failure.
authors.affiliation: Department of Intensive Care, Austin and Repatriation Medical Centre, Melbourne, Victoria, Australia.
authors.forename: I
authors.initials: I
authors.lastname: Baldwin
authors.forename: H K
authors.initials: HK
authors.lastname: Tan
authors.forename: N
authors.initials: N
authors.lastname: Bridge
authors.forename: R
authors.initials: R
authors.lastname: Bellomo
mesh_terms: D000925:Anticoagulants / Q000008:administration & dosage*; D016638:Critical Illness; D004305:Dose-Response Relationship, Drug; D004869:Equipment Safety; D005260:Female; D006440:Hemofiltration / Q000295:instrumentation* / Q000379:methods; D006493:Heparin / Q000008:administration & dosage*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008851:Micropore Filters; D010865:Pilot Projects; D011336:Probability; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013916:Thrombelastography / Q000187:drug effects* / Q000379:methods; D013923:Thromboembolism / Q000517:prevention & control; D013997:Time Factors; D014654:Vascular Patency
chemical_list: D000925:Anticoagulants; D006493:Heparin