Key result
Prostacyclin anticoagulation was associated with significantly shorter median filter lifetimes compared to citrate (26 vs 36.5 hours; p<0.01) during continuous haemodiafiltration.
Why the study?
Does epoprostenol plus heparin improve filter lifetime and safety compared to citrate in mechanically ventilated patients undergoing continuous haemodiafiltration?
Observational (n=32)
Does epoprostenol plus heparin improve filter lifetime and safety compared to citrate in mechanically ventilated patients undergoing continuous haemodiafiltration?
Absolute Event Rate: 26% vs 36.5%
p-value: p=< 0.01
Citrate anticoagulation provides longer filter survival, a better safety profile, and lower costs compared to epoprostenol plus heparin during continuous haemodiafiltration.
Citrate may extend filter survival over prostacyclin in continuous haemodiafiltration; leaves open confirmation in randomized trials.
BACKGROUND: The efficacy and safety of prostacyclin (PGI2) and citrate (ACD) anticoagulation were observed and compared during continuous haemodiafiltration. METHODS: Mechanically ventilated patients received either the PGI2 analogue epoprostenol (group A, n = 17) in escalating doses of 4.5-10.0 ng.kg(-1).min(-1) in combination with heparin (6 IU.kg(-1).h(-1)) or 2.2% ACD (group B, n = 15). Blood flow was set to match the circuit-filling volume per unit time equal to the intravascular half-life of PGI2. RESULTS: Median filter lifetimes were 26 h (interquartile range 16-37) in group A (39 filters) and 36.5 h (interquartile range 23-50) in group B (56 filters; p < 0.01). In group A, 4 patients (23.5%, p < 0.05) had the dose reduced due to hypotension. The final mean dose of PGI2 was 8.7 +/- 2.4 ng.kg(-1).min(-1). Four patients in group A (23.5%, p < 0.05) were switched to ACD due to a decrease in platelet count. No bleeding episodes, decrease in platelet count or adverse haemodynamic effects were encountered in group B. The cost of epoprostenol plus low dose heparin (EUR 204.73 +/- 53.04) was significantly higher than the cost of ACD-based anticoagulation (EUR 93.92 +/- 45.2, p < 0.05). CONCLUSION: ACD offers longer filter survival, has no impact on platelet count and is less expensive. Increasing the dose of PGI2 up to the average of 8.7 ng.kg(-1).min(-1) did not increase the haemodynamic side effects.
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Balík et al. (2005) conducted an observational in High risk of bleeding requiring continuous haemodiafiltration (n=32). Prostacyclin (epoprostenol) plus heparin vs. 2.2% Citrate (ACD) was evaluated on Filter lifetime (p=< 0.01). Prostacyclin anticoagulation was associated with significantly shorter median filter lifetimes compared to citrate (26 vs 36.5 hours; p<0.01) during continuous haemodiafiltration.
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