Bivalirudin versus Unfractionated Heparin for Prevention of Hemofilter Occlusion During Continuous Renal Replacement Therapy

Kiser, Tyree H.; MacLaren, Robert; Fish, Douglas N.; Hassell, Kathryn L.; Teitelbaum, Isaac

doi:10.1592/phco.30.11.1117

Cited by 24 publications

(10 citation statements)

References 46 publications

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“…Of interest were studies [ 32 , 33 , 35 , 67 , 73 ] reporting heparin resistance from low anti-thrombin III levels (AT-III). Higher AT-III levels trended to longer filter life, reaching significance in one study [ 33 ] while correction of AT-III deficiency was associated with a pooled 18.8% increase in filter life.…”

Section: Resultsmentioning

confidence: 99%

Non anti-coagulant factors associated with filter life in continuous renal replacement therapy (CRRT): a systematic review and meta-analysis

et al. 2017

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BackgroundOptimising filter life and performance efficiency in continuous renal replacement therapy has been a focus of considerable recent research. Larger high quality studies have predominantly focussed on optimal anticoagulation however CRRT is complex and filter life is also affected by vascular access, circuit and management factors. We performed a systematic search of the literature to identify and quantify the effect of vascular access, circuit and patient factors that affect filter life and presented the results as a meta-analysis.MethodsA systematic review and meta-analysis was performed by searching Pubmed (MEDLINE) and Ovid EMBASE libraries from inception to 29th February 2016 for all studies with a comparator or independent variable relating to CRRT circuits and reporting filter life. Included studies documented filter life in hours with a comparator other than anti-coagulation intervention. All studies comparing anticoagulation interventions were searched for regression or hazard models pertaining to other sources of variation in filter life.ResultsEight hundred nineteen abstracts were identified of which 364 were selected for full text analysis. 24 presented data on patient modifiers of circuit life, 14 on vascular access modifiers and 34 on circuit related factors. Risk of bias was high and findings are hypothesis generating.Ranking of vascular access site by filter longevity favours: tunnelled semi-permanent catheters, femoral, internal jugular and subclavian last. There is inconsistency in the difference reported between femoral and jugular catheters.Amongst published literature, modality of CRRT consistently favoured continuous veno-venous haemodiafiltration (CVVHD-F) with an associated 44% lower failure rate compared to CVVH. There was a trend favouring higher blood flow rates. There is insufficient data to determine advantages of haemofilter membranes.Patient factors associated with a statistically significant worsening of filter life included mechanical ventilation, elevated SOFA or LOD score, elevations in ionized calcium, elevated platelet count, red cell transfusion, platelet factor 4 (PF-4) antibodies, and elevated fibrinogen.Majority of studies are observational or report circuit factors in sub-analysis. Risk of bias is high and findings require targeted investigations to confirm.ConclusionThe interaction of patient, pathology, anticoagulation, vascular access, circuit and staff factors contribute to CRRT filter life. There remains an ambiguity from published data as to which site and side should be the first choice for vascular access placement and what interaction this has with patient factors and timing. Early consideration of tunnelled semi-permanent access may provide optimal filter life if longer periods of CRRT are anticipated. There remains an absence of robust evidence outside of anti-coagulation strategies despite over 20 years of therapy delivery however trends favour CVVHD-F over CVVH.

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Section: Resultsmentioning

confidence: 99%

Non anti-coagulant factors associated with filter life in continuous renal replacement therapy (CRRT): a systematic review and meta-analysis

et al. 2017

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“…This suggests that it may be important to target coagulation proteinases that do not rely on the presence of circulating endogenous anticoagulants. In this context, some reports suggest that bivalirudin may improve haemofilter and extracorporeal membrane oxygenation filter survival [99,100].…”

Section: The Potential Of Targeting Coagulation In Covid-19mentioning

confidence: 99%

Targeting coagulation activation in severe COVID-19 pneumonia: lessons from bacterial pneumonia and sepsis

et al. 2020

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Novel coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), has rapidly spread throughout the world, resulting in a pandemic with high mortality. There are no effective treatments for the management of severe COVID-19 and current therapeutic trials are focused on antiviral therapy and attenuation of hyper-inflammation with anti-cytokine therapy. Severe COVID-19 pneumonia shares some pathological similarities with severe bacterial pneumonia and sepsis. In particular, it disrupts the haemostatic balance, which results in a procoagulant state locally in the lungs and systemically. This culminates in the formation of microthrombi, disseminated intravascular coagulation and multi-organ failure. The deleterious effects of exaggerated inflammatory responses and activation of coagulation have been investigated in bacterial pneumonia and sepsis and there is recognition that although these pathways are important for the host immune response to pathogens, they can lead to bystander tissue injury and are negatively associated with survival. In the past two decades, evidence from preclinical studies has led to the emergence of potential anticoagulant therapeutic strategies for the treatment of patients with pneumonia, sepsis and acute respiratory distress syndrome, and some of these anticoagulant approaches have been trialled in humans. Here, we review the evidence from preclinical studies and clinical trials of anticoagulant treatment strategies in bacterial pneumonia and sepsis, and discuss the importance of these findings in the context of COVID-19.

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“…In case of bleeding, no antidote exists and rFVIIa or FFP may be needed. Yet, in general, results from its use in CRRT are comparable with UFH protocols [67][68][69] .…”

Section: Hirudin Lepirudin and Bivalirudinmentioning

confidence: 99%

Anticoagulation during continuous renal replacement therapy: An update

Aslanidis¹,

Karakosta²,

Myrou³

2019

Serb J Anest Inten Therapy

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Renal replacement therapy in Intensive Care Units is a daily practice worldwide. Ensuring blood flow continuum within extracorporeal circuit is one of the basic tasks during therapy. Unfractionated heparin remains the most popular anticoagulant used. Alternatives, such as low molecular weight heparins, prostacyclin, fondaparinux, or regional use of citrate or nafomostate mesilate are also gaining ground, mainly due to their safety profile. Still, there is no worldwide consensus about their use. Systemic, regional, combined or no coagulation at all; the final choice depends on the patients' characteristics and co-morbidities, as well as institutional and organizational protocols, equipment availability and staff education. This article presents a review of the current modalities for anticoagulation during continuous renal replacement therapy.

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Bivalirudin versus Unfractionated Heparin for Prevention of Hemofilter Occlusion During Continuous Renal Replacement Therapy

Abstract: Compared with heparin, bivalirudin was more efficacious in prolonging hemofilter survival time and was well tolerated. Additional studies of bivalirudin for prevention of hemofilter occlusion during continuous renal replacement therapy are warranted.

Cited by 24 publications

References 46 publications

Non anti-coagulant factors associated with filter life in continuous renal replacement therapy (CRRT): a systematic review and meta-analysis

Non anti-coagulant factors associated with filter life in continuous renal replacement therapy (CRRT): a systematic review and meta-analysis

Targeting coagulation activation in severe COVID-19 pneumonia: lessons from bacterial pneumonia and sepsis

Anticoagulation during continuous renal replacement therapy: An update

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