Intermittent hirudin versus continuous heparin for anticoagulation in continuous renal replacement therapy.
BACKGROUND
Besides possible bleeding complications a further problem in anticoagulation during continuous renal replacement therapy (CRRT) is the development of heparin-induced thrombocytopenia type II (HIT II) where further anticoagulation with heparin is contraindicated. The application of continuous hirudin as alternative for heparin caused bleeding complications by comparable filter efficacy. Aim of this prospective-controlled pilot study was to compare the efficacy and safety of intermittent hirudin and continuous heparin for anticoagulation during CRRT in critically ill patients.


METHODS
26 patients receiving CRRT were randomly allocated to two groups: Heparin group (14 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 (12 patients): initial bolus application of 2-2-5 microg/kg hirudin, dose was adjusted in 2 microg/kg bolus steps with a targeted ecarin clotting time (ECT) >80 s. Observation time was 96 hours.


RESULTS
Measured filter run time was virtually longer for heparin. No bleeding complications were observed in the hirudin group, two bleeding complications in the heparin group.


CONCLUSIONS
Intermittent hirudin can be used safely for anticoagulation in CRRT. However, the in tendency better filter survival for heparin elucidates the need for further investigations to find the right dosage equilibrium between filter clotting and bleeding complications.
Hein
Ortrud Vargas
OV
Department of Anesthesiology and Intensive Care, University Hospital Charité, Berlin, Germany. ortrud.vargas@charite.de
von Heymann
Christian
C
Diehl
Thorsten
T
Ziemer
Sabine
S
Ronco
Claudio
C
Morgera
Stanislao
S
Siebert
Gerda
G
Kox
Wofgang J
WJ
Neumayer
Hans H
HH
Spies
Claudia
C
D058186:Acute Kidney Injury / Q000628:therapy*; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage* / Q000627:therapeutic use; D005260:Female; D006440:Hemofiltration; D006493:Heparin / Q000008:administration & dosage* / Q000627:therapeutic use; D024764:Hirudin Therapy / Q000379:methods*; D006629:Hirudins / Q000008:administration & dosage; D006801:Humans; D008297:Male; D010865:Pilot Projects; D011446:Prospective Studies; D013921:Thrombocytopenia / Q000139:chemically induced
D000925:Anticoagulants; D006629:Hirudins; D006493:Heparin