Anticoagulation with prostaglandins and unfractionated heparin during continuous venovenous haemofiltration: a randomized controlled trial.
BACKGROUND
The objective of this prospective, randomized, controlled clinical study was to compare efficacy, safety, and costs of fixed-dose prostaglandins with adjusted-dose unfractionated heparin as anticoagulants for continuous venovenous haemofiltration.


METHODS
Perioperative critically ill patients requiring continuous haemofiltration for acute renal failure received unfractionated heparin anticoagulation titrated to achieve an activated clotting time in the extracorporeal system of > 120 s. Patients were randomly assigned to receive a test infusion containing either prostaglandin I2 (5 ng/kg/min; group I; n = 15; 75 filters), prostaglandin E1 (5 ng/kg/min; group E; n = 18; 72 filters), or placebo (group H; n = 17; 63 filters). Heparin and test solutions were infused into the extracorporeal circuit before the haemofilter. All AN69-surface hollow fiber filters were primed with normal saline containing 5.000 IU heparin.


RESULTS
The primary outcome measure--adequate haemofilter life span > 24 h--was compared by using Cochran's Q test. There was a significant difference in the frequencies of adequate haemofilter life span between the groups (36% group H, 65% group I, 59% group E; P < 0.05 versus group H). There were 6 bleeding episodes in group H, 2 in group E, and only 1 trivial bleeding episode in group I (P < 0.05 versus group H). Daily costs of haemofiltration were 61% higher in group I and 23% higher in group E than in group H (P < 0.05 versus group H). A heparin-sparing effect of prostaglandins was observed.


CONCLUSIONS
Fixed-dose prostaglandins I2 and E1 reduced the incidence of haemofilter failure and bleeding when compared with adjusted-dose unfractionated heparin. There was no significant difference between the two prostaglandin groups. The increase in daily costs for haemofiltration treatment under prostaglandins is not clinically relevant.
Kozek-Langenecker
Sibylle A
SA
Departments of Anaesthesiology and Intensive Care B, University of Vienna, School of Medicine, Vienna, Austria. sibylle.kozek@univie.ac.at
Spiss
Christian K
CK
Gamsjäger
Thomas
T
Domenig
Christoph
C
Zimpfer
Michael
M
D058186:Acute Kidney Injury / Q000401:mortality / Q000628:therapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000527:Alprostadil / Q000008:administration & dosage / Q000627:therapeutic use*; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D001780:Blood Coagulation Tests; D002423:Cause of Death; D004311:Double-Blind Method; D011464:Epoprostenol / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006440:Hemofiltration; D006493:Heparin / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality / Q000628:therapy*; D012772:Shock, Septic / Q000401:mortality / Q000628:therapy*; D015996:Survival Rate
D000925:Anticoagulants; D006493:Heparin; D011464:Epoprostenol; D000527:Alprostadil