title: [Use of isolated epoprostenol or associated to heparin for the maintenance of the patency of the continuous renal replacement technical circuits].
abstract: OBJECTIVE
  At present, there is no consensus on the best anticoagulant regimen for the maintenance of extrarenal clearance circuits (RRTC). We present our experience with the isolated use of epoprostenol in patients at risk of bleeding or associated to non-fractionated heparin (nFH) in patients with problems of early coagulation of the filters.
  
  
  METHODS
  Prospective study of cohorts on all the RRTC filters used in our service since 1994.
  
  
  METHODS
  Forty-two-bed polyvalent ICU in a tertiary hospital.
  
  
  METHODS
  Anticoagulation was administered in prefilter perfusion, at doses of 5-7 U/kg/hour for nFH or 4-5 ng/kg/min for epoprostenol. The combined use was done with equal doses of epoprostenol and nFH at 2,5 U/kg/hour. VARIABLES OF MAIN INTEREST: We analyzed the duration of each filter, reason for removing the filter, existence of coagulopathy, platelet count, appearance of bleeding, anticoagulant used and dose.
  
  
  RESULTS
  We analyzed the use of 2,322 filters (66,957 hours) in 389 patients, 54% of whom had a clot. nFH was used in 74% of the filters for a median of 39 hours (interquartile range: 19-75), epoprostenol in 6% for 32 hours (interquartile range: 17-48) and combined therapy in 4% for 27 hours (interquartile range: 19-41). In the epoprostenol group, we detected a decrease in blood pressure in only two filters that became normal when the dose was decreased. The filters that were initially anticoagulated with nFH had a 14-hour survival as a median versus 27 hours in combined therapy (p < 0.001). In absence of coagulopathy or thrombopenia, we observed mild bleeding in 8%, moderate in 1% and serious in 1% in the 1,170 filters treated with nFH. We only observed mild bleeding in 3% in 66 filters with epoprostenol.
  
  
  CONCLUSIONS
  Isolated epoprostenol in patients at risk of bleeding provided a similar duration of the filters to nFH, decreasing the risk of bleeding. The use of epoprostenol plus low dose nFH significantly increases their duration in patients with early coagulation.
authors.affiliation: Servicio de Cuidados Críticos y Urgencias, Complejo Hospitalario Hospital Universitario Carlos Haya, Málaga, España. mehguci@wanadoo.es
authors.forename: M E
authors.initials: ME
authors.lastname: Herrera-Gutiérrez
authors.forename: G
authors.initials: G
authors.lastname: Seller-Pérez
authors.forename: M
authors.initials: M
authors.lastname: Lebrón-Gallardo
authors.forename: J P
authors.initials: JP
authors.lastname: De La Cruz-Cortés
authors.forename: J A
authors.initials: JA
authors.lastname: González-Correa
mesh_terms: D058186:Acute Kidney Injury / Q000628:therapy; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D002406:Catheterization, Peripheral / Q000379:methods*; D011464:Epoprostenol / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D005268:Femoral Vein / Q000502:physiology*; D017583:Hemodiafiltration / Q000295:instrumentation* / Q000379:methods; D006470:Hemorrhage / Q000139:chemically induced; D006493:Heparin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014654:Vascular Patency / Q000187:drug effects*
chemical_list: D000925:Anticoagulants; D006493:Heparin; D011464:Epoprostenol