Regional filter heparinization for continuous veno-venous hemofiltration in liver transplant recipients.
OBJECTIVE
To study safety, clinical and operative feasibility of continuous veno-venous hemofiltration (CVVH) with anticoagulation only of the filter in patients at risk for bleeding.


METHODS
This prospective, comparative, non randomised study was completed at an intensive care unit of a teaching NHS hospital. Sixteen liver transplant (LT) recipients with acute renal failure needing CVVH were treated with a regional anticoagulation protocol (heparin and protamine were administered respectively pre- and post-filter) and compared to 11 critically ill subjects who received a standard low-heparin treatment. Activated coagulation time (ACT) monitoring was used to adjust anticoagulation and heparin neutralization.


RESULTS
Mean circuit life was 35.8+/-13.6 hours (95% CI 28.5-43.1) in patients receiving regional anticoagulation and 34.4+/-14 hours in controls (95% CI 25.5-43.3; p=0.7). Fourty-eight circuits (47.5% of the total) in the heparin-protamine group had a life-span longer than 30 hours and other 22 (21.7%) were changed intentionally after 24 hours of use in absence of clots. None of the patients in both the studied groups had bleeding or hemodynamic complications and their azotemic control was always satisfactory.


CONCLUSIONS
In LT recipients, regional anticoagulation can achieve a circuits life-span comparable to that from systemic anticoagulation with satisfactory safety and simplicity of use.
Biancofiore
G
G
Post-surgical and Transplant Intensive Care Unit, 1st Department of Anaesthesia and Intensive Care, Cisanello Hospital, Pisa, Italy. g.biancofiore@med.unipi.it
Esposito
M
M
Bindi
L
L
Stefanini
A
A
Bisà
M
M
Boldrini
A
A
Consani
G
G
Filipponi
F
F
Mosca
F
F
D058186:Acute Kidney Injury / Q000097:blood / Q000628:therapy*; D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage / Q000627:therapeutic use*; D003422:Critical Care; D005240:Feasibility Studies; D005260:Female; D006440:Hemofiltration / Q000295:instrumentation / Q000379:methods*; D006470:Hemorrhage / Q000517:prevention & control; D006801:Humans; D015993:Life Tables; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control / Q000628:therapy*; D011446:Prospective Studies
D000925:Anticoagulants