Continuous renal replacement therapies: Anticoagulation in the critically ill at high risk of bleeding

Santo Morabito, Isabella Guzzo, Angela Solazzo, Lina Muzi, Remo Luciani, Alessandro Pierucci

Research output: Contribution to journalArticlepeer-review

Abstract

Background: The ongoing necessity for systemic heparinization is a well-known disadvantage of continuous renal replacement therapies (CRRT), and alternative methods of anticoagulation may be required. Our aim was to evaluate, in patients with a high risk of bleeding, the possibility of an acceptable filter life with non-anticoagulation CRRT and, in case of early filter failure, the efficacy and safety of bedside monitored regional anticoagulation with heparin and protamine. Methods: Fifty-nine patients underwent CRRT for acute renal failure (ARF) following cardiac surgery. Patients who fulfilled one of the following criteria were selected for non-anticoagulation CRRT: spontaneous bleeding, aPTT >45 sec, thrombocytopenia and recent surgery (55 sec. Results: Twenty-two (37.3%) patients had been selected for non-anticoagulation. Of them, 12 patients continued to receive non-anticoagulation (filter life: 38.3 ± 30.5 hr) while 10 switched to regional anticoagulation (filter life: 38.6 ± 25 hr). During regional anticoagulation no statistical difference was found between baseline aPTT (36.7 ± 6.4 sec) and patient aPTT (41.5 ± 12.6 sec) while circuit aPTT (77.7 ± 43.3 sec) was significantly higher than patient aPTT (p

Original languageEnglish
Pages (from-to)566-571
Number of pages6
JournalJournal of Nephrology
Volume16
Issue number4
Publication statusPublished - Jul 2003

Keywords

  • Acute renal failure
  • Continuous renal replacement therapies
  • CRRT
  • CVVH
  • CVVHD
  • CVVHDF
  • Heparin
  • Protamine
  • Regional anticoagulation

ASJC Scopus subject areas

  • Nephrology

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