Role of prostacyclin (epoprostenol) as anticoagulant in continuous renal replacement therapies: efficacy, security and cost analysis.
BACKGROUND
Heparin remains the drug most commonly used for anticoagulation in continuous renal replacement therapies (CRRTs). However, in patients with hypercoagulability, heparin is insufficient or, in cases with an increased risk of bleeding or thrombocytopenia, it may be contraindicated. Epoprostenol, a potent vasodilator, antithrombotic and antiplatelet agent, could be an alternative.


METHODS
We studied the records of patients treated under continuous venovenous hemodiafiltration in an academic tertiary hospital of 900 beds, between January 2000 and June 2003. Epoprostenol was prescribed to patients with (i) filter hypercoagulability, defined as consumption of 2 or more filters in the last 24 hours; (ii) low platelet count; or (iii) recent severe hemorrhage.


RESULTS
Thirty-eight out of 248 (15%) patients who were under CRRT received epoprostenol for more than 72 hours. Epoprostenol was indicated due to filter hypercoagulability in 48%, thrombocytopenia in 68% (7 patients both) and hemorrhage in 3% of cases. The overall time for epoprostenol therapy was 9,749 hours. The mean filter duration previous to epoprostenol was 23 +/- 12 hours and after administering this drug 38.2 +/- 11.9 hours (p = 0.0001). In 6 patients, heparin and epoprostenol were simultaneously administered. The adverse effects were hemorrhage, which presented in 7 patients (18%) and a fall in blood pressure in another 7 (18%), which recovered in the next 24 hour after starting treatment. Cost analysis demonstrates some advantage with epoprostenol in patients with increased tendency to clotting.


CONCLUSIONS
Epoprostenol may be safely used to prevent clotting of the extracorporeal circuits, either alone in patients with thrombocytopenia and/or increased risk of bleeding, or in combination with heparin in states of hypercoagulability.
Gainza
Francisco J
FJ
Nephrology Department, Hospital de Cruces, Barakaldo, Bizkaia-Spain. fjgainza@hcru.oskidetza.net
Quintanilla
Nuria
N
Pijoan
Jose I
JI
Delgado
Sonia
S
Urbizu
Jose M
JM
Lampreabe
Ildefonso
I
D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics; D001794:Blood Pressure / Q000187:drug effects; D003365:Costs and Cost Analysis; D064420:Drug-Related Side Effects and Adverse Reactions; D011464:Epoprostenol / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics*; D005260:Female; D006470:Hemorrhage / Q000097:blood / Q000191:economics / Q000517:prevention & control; D006493:Heparin / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics; D006801:Humans; D008297:Male; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics*; D010976:Platelet Count; D017582:Renal Replacement Therapy / Q000009:adverse effects / Q000191:economics*; D012189:Retrospective Studies; D012307:Risk Factors; D013921:Thrombocytopenia / Q000097:blood / Q000191:economics / Q000517:prevention & control; D019851:Thrombophilia / Q000097:blood / Q000191:economics / Q000628:therapy; D013997:Time Factors; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000097:blood / Q000191:economics
D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D014665:Vasodilator Agents; D006493:Heparin; D011464:Epoprostenol