Regional anticoagulation and antiaggregation for CVVH in critically ill patients: a prospective, randomized, controlled pilot study.
BACKGROUND
The aim of this study is to assess the efficacy and clinical safety of regional anticoagulation (heparin pre-filter plus post-filter protamine) plus antiaggregation (pre-filter prostacyclin) [Group 1 (G1)] vs. only systemic heparin anticoagulation without antiaggregation [Group 2 (G2)] in critically ill patients with acute renal failure undergoing continuous veno-venous haemofiltration (CVVH).


METHODS
One hundred and ten patients were randomized in a prospective, controlled pilot study. G1 patients received 1000 U/h pre-filter heparin, 10 mg/h post-filter protamine sulphate and 4 ng/kg/min pre-filter prostacyclin, while G2 patients received 1000 U/h pre-filter heparin. The haemofilter transmembrane pressure (TMP) and lifespan, as well as the platelet count were observed 1 h before, and at 6, 12, 18, 24 and 36 h from the beginning of CVVH.


RESULTS
Haemofilter TMP remained unchanged in G1 while it increased up to three times in G2 (P=0.0002). The median filter lifespan was 68 h in G1 and 19 h in G2. The rate of spontaneous circuit failure was 24% in G1 and 93% in G2 (P=0.0001). The platelet count was stable over the treatment period in G1 while in G2 it decreased progressively (P=0.0073).


CONCLUSIONS
In critically ill patients suffering from acute renal failure, regional anticoagulation with pre-filter heparin and post-filter protamine plus antiaggregation during CVVH is a simple and safe procedure that prevents increases in filter TMP and increases circuit life time compared with systemic anticoagulation with pre-filter heparin only.
Fabbri
L P
LP
Department of Medical and Surgical Critical Care, Florence University, Florence, Italy.
Nucera
M
M
Al Malyan
M
M
Becchi
C
C
D058186:Acute Kidney Injury / Q000503:physiopathology / Q000628:therapy*; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage*; D016638:Critical Illness; D011464:Epoprostenol / Q000008:administration & dosage; D005260:Female; D006440:Hemofiltration / Q000379:methods* / Q000706:statistics & numerical data; D006493:Heparin / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008851:Micropore Filters; D010865:Pilot Projects; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage; D010976:Platelet Count; D011446:Prospective Studies; D011479:Protamines / Q000008:administration & dosage*; D013997:Time Factors; D016896:Treatment Outcome
D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D011479:Protamines; D006493:Heparin; D011464:Epoprostenol