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)] i...
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| Veröffentlicht in: | Acta anaesthesiologica Scandinavica 2010-01, Vol.54 (1), p.92-97 |
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| description | 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).
Conclusion: 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. |
| doi_str_mv | 10.1111/j.1399-6576.2009.02031.x |
| format | Article |
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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).
Conclusion: 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.</description><identifier>ISSN: 0001-5172</identifier><identifier>EISSN: 1399-6576</identifier><identifier>DOI: 10.1111/j.1399-6576.2009.02031.x</identifier><identifier>PMID: 19650808</identifier><identifier>CODEN: AANEAB</identifier><language>eng</language><publisher>Oxford, UK: Blackwell Publishing Ltd</publisher><subject><![CDATA[Acute Kidney Injury - physiopathology ; Acute Kidney Injury - therapy ; Aged ; Anesthesia ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Anticoagulants - administration & dosage ; Biological and medical sciences ; Critical Illness ; Epoprostenol - administration & dosage ; Female ; Hemofiltration - methods ; Hemofiltration - statistics & numerical data ; Heparin - administration & dosage ; Humans ; Male ; Medical sciences ; Micropore Filters ; Pilot Projects ; Platelet Aggregation Inhibitors - administration & dosage ; Platelet Count ; Prospective Studies ; Protamines - administration & dosage ; Time Factors ; Treatment Outcome]]></subject><ispartof>Acta anaesthesiologica Scandinavica, 2010-01, Vol.54 (1), p.92-97</ispartof><rights>2009 The Authors. Journal compilation © 2009 The Acta Anaesthesiologica Scandinavica Foundation</rights><rights>2015 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4361-f19e55cb798d2868f00c91a4cbbf2002f32006842822f8f18dad9dcb17d172713</citedby><cites>FETCH-LOGICAL-c4361-f19e55cb798d2868f00c91a4cbbf2002f32006842822f8f18dad9dcb17d172713</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fj.1399-6576.2009.02031.x$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fj.1399-6576.2009.02031.x$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,4010,27902,27903,27904,45553,45554</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=22208083$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19650808$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>FABBRI, L. P.</creatorcontrib><creatorcontrib>NUCERA, M.</creatorcontrib><creatorcontrib>AL MALYAN, M.</creatorcontrib><creatorcontrib>BECCHI, C.</creatorcontrib><title>Regional anticoagulation and antiaggregation for CVVH in critically ill patients: a prospective, randomized, controlled pilot study</title><title>Acta anaesthesiologica Scandinavica</title><addtitle>Acta Anaesthesiol Scand</addtitle><description>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).
Conclusion: 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.</description><subject>Acute Kidney Injury - physiopathology</subject><subject>Acute Kidney Injury - therapy</subject><subject>Aged</subject><subject>Anesthesia</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Anticoagulants - administration & dosage</subject><subject>Biological and medical sciences</subject><subject>Critical Illness</subject><subject>Epoprostenol - administration & dosage</subject><subject>Female</subject><subject>Hemofiltration - methods</subject><subject>Hemofiltration - statistics & numerical data</subject><subject>Heparin - administration & dosage</subject><subject>Humans</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Micropore Filters</subject><subject>Pilot Projects</subject><subject>Platelet Aggregation Inhibitors - administration & dosage</subject><subject>Platelet Count</subject><subject>Prospective Studies</subject><subject>Protamines - administration & dosage</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><issn>0001-5172</issn><issn>1399-6576</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2010</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkctu1DAUhi0EokPhFZA3iE0TbOdmI7EYDdBWLXco7CzHl8iDJwl2AjPd8uJ1JqNhixe2z_H3H9v_AQBilOI4XqxTnDGWlEVVpgQhliKCMpxu74HF8eA-WCCEcFLgipyARyGsY5jljD0EJ5iVBaKILsDfz7qxXSscFO1gZSea0YkhZmKs9jnRNF43c850Hq5ubi6gbaH0NgqEcztonYN9JHQ7hJdQwN53oddysL_1GfSxULext1qdQdm1g--c0wr21nUDDMOodo_BAyNc0E8O6yn49vbN19VFcv3h_HK1vE5knpU4MZjpopB1xagitKQGIcmwyGVdm2gCMVmcS5oTSoihBlMlFFOyxpWKFlQ4OwXP57rxfb9GHQa-sUFq50SruzHwKstxhfO8iCSdSRl_Erw2vPd2I_yOY8SnDvA1n4zmk9F86gDfd4Bvo_Tp4ZKx3mj1T3iwPALPDoAI0T4T_ZE2HDlCyB6L3KuZ-2Od3v33A_hy-WXaRX0y620Y9PaoF_4nL6usKvj39-f807sSvb768ZGj7A7Io7JX</recordid><startdate>201001</startdate><enddate>201001</enddate><creator>FABBRI, L. P.</creator><creator>NUCERA, M.</creator><creator>AL MALYAN, M.</creator><creator>BECCHI, C.</creator><general>Blackwell Publishing Ltd</general><general>Blackwell</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201001</creationdate><title>Regional anticoagulation and antiaggregation for CVVH in critically ill patients: a prospective, randomized, controlled pilot study</title><author>FABBRI, L. P. ; NUCERA, M. ; AL MALYAN, M. ; BECCHI, C.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4361-f19e55cb798d2868f00c91a4cbbf2002f32006842822f8f18dad9dcb17d172713</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2010</creationdate><topic>Acute Kidney Injury - physiopathology</topic><topic>Acute Kidney Injury - therapy</topic><topic>Aged</topic><topic>Anesthesia</topic><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Anticoagulants - administration & dosage</topic><topic>Biological and medical sciences</topic><topic>Critical Illness</topic><topic>Epoprostenol - administration & dosage</topic><topic>Female</topic><topic>Hemofiltration - methods</topic><topic>Hemofiltration - statistics & numerical data</topic><topic>Heparin - administration & dosage</topic><topic>Humans</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Micropore Filters</topic><topic>Pilot Projects</topic><topic>Platelet Aggregation Inhibitors - administration & dosage</topic><topic>Platelet Count</topic><topic>Prospective Studies</topic><topic>Protamines - administration & dosage</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>FABBRI, L. P.</creatorcontrib><creatorcontrib>NUCERA, M.</creatorcontrib><creatorcontrib>AL MALYAN, M.</creatorcontrib><creatorcontrib>BECCHI, C.</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Acta anaesthesiologica Scandinavica</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>FABBRI, L. P.</au><au>NUCERA, M.</au><au>AL MALYAN, M.</au><au>BECCHI, C.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Regional anticoagulation and antiaggregation for CVVH in critically ill patients: a prospective, randomized, controlled pilot study</atitle><jtitle>Acta anaesthesiologica Scandinavica</jtitle><addtitle>Acta Anaesthesiol Scand</addtitle><date>2010-01</date><risdate>2010</risdate><volume>54</volume><issue>1</issue><spage>92</spage><epage>97</epage><pages>92-97</pages><issn>0001-5172</issn><eissn>1399-6576</eissn><coden>AANEAB</coden><abstract>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).
Conclusion: 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.</abstract><cop>Oxford, UK</cop><pub>Blackwell Publishing Ltd</pub><pmid>19650808</pmid><doi>10.1111/j.1399-6576.2009.02031.x</doi><tpages>6</tpages></addata></record> |
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| source | MEDLINE; Wiley Online Library Journals Frontfile Complete |
| subjects | Acute Kidney Injury - physiopathology Acute Kidney Injury - therapy Aged Anesthesia Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Anticoagulants - administration & dosage Biological and medical sciences Critical Illness Epoprostenol - administration & dosage Female Hemofiltration - methods Hemofiltration - statistics & numerical data Heparin - administration & dosage Humans Male Medical sciences Micropore Filters Pilot Projects Platelet Aggregation Inhibitors - administration & dosage Platelet Count Prospective Studies Protamines - administration & dosage Time Factors Treatment Outcome |
| title | Regional anticoagulation and antiaggregation for CVVH in critically ill patients: a prospective, randomized, controlled pilot study |
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