Hirudin versus heparin for anticoagulation in continuous renal replacement therapy.
OBJECTIVE
To compare the efficacy and safety of hirudin and heparin for anticoagulation during continuous renal replacement therapy (CRRT) in critically ill patients.


METHODS
Prospective, randomized controlled pilot study.


METHODS
Single centre; interdisciplinary intensive care unit at a university hospital.


METHODS
Seventeen patients receiving CRRT.


METHODS
Patients were randomly allocated to two groups. Heparin group (nine patients): continuous administration of 250 IU/h heparin; dose was adjusted in 125 IU/h steps with a targeted activated clotting time (ACT) of 180-210 s. Hirudin group (eight patients): continuous infusion of 10 micrograms/kg/h hirudin, dose was adjusted in 2 micrograms/kg/h steps with a targeted ecarin clotting time (ECT) of 80-100 s. Observation time was 96 h.


RESULTS
Measured filter run patency and haemofiltration efficacy did not significantly differ between the two groups. Three bleeding complications were observed in the hirudin group, none in the heparin group (P < 0.01). At the onset of bleeding, which occurred 60 or more hours after the start of therapy, only one patient was still under continuous hirudin administration but levels were either in therapeutic range or below.


CONCLUSIONS
Hirudin can be used efficiently for anticoagulation in CRRT. Late bleeding complications may have been caused by possible hirudin accumulation, but this was not evident from hirudin plasma and ECT levels. Since bleeding complications were observed only in the presence of documented coagulation disorders, not only adequate drug monitoring but also the plasmatic and cellular coagulation status of the patient should be taken into consideration for adjusting hirudin dosage.
Vargas Hein
O
O
Department of Anesthesiology and Intensive Care, University Hospital Charité, Campus Mitte, Schumannstrasse 20/21, 10117 Berlin, Germany. ortrud.vargas@charite.de
von Heymann
C
C
Lipps
M
M
Ziemer
S
S
Ronco
C
C
Neumayer
H H
HH
Morgera
S
S
Welte
M
M
Kox
W J
WJ
Spies
C
C
D018806:APACHE; D058186:Acute Kidney Injury / Q000097:blood / Q000628:therapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D001778:Blood Coagulation Disorders / Q000097:blood / Q000209:etiology; D001780:Blood Coagulation Tests; D003131:Combined Modality Therapy; D005260:Female; D006470:Hemorrhage / Q000097:blood / Q000209:etiology; D006493:Heparin / Q000009:adverse effects* / Q000627:therapeutic use*; D024764:Hirudin Therapy; D006629:Hirudins / Q000009:adverse effects*; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure; D017582:Renal Replacement Therapy
D000925:Anticoagulants; D006629:Hirudins; D006493:Heparin