Continuous Venovenous Hemofiltration Without Anticoagulation

Abstract

We conducted a prospective observational study to assess the efficacy of continuous venovenous hemofiltration (CVVH) with no anticoagulation. A standard anticoagulation protocol for CVVH, which prescribed no anticoagulation for patients at risk of bleeding, was applied to 48 critically ill patients treated with CVVH. Circuit life was prospectively observed, and the following data were obtained for each circuit: heparin use and dose, protamine use, daily prothrombin time-international normalized ratio, activated partial thromboplastin time, and platelet count. Out of 300 consecutive circuits, 143 (47.6%) received no anticoagulation, 31 (10.3%) received regional anticoagulation, and 126 received low dose heparin. No patients experienced bleeding complications secondary to CVVH. Platelet count was significantly lower in the no anticoagulation group (73 x 10(3)/microl) compared with the low dose heparin group (119 x 10(3)/microl) and the protamine group (104 x 10(3)/microl) (p < 0.01 for both comparisons). There was no significant difference in mean circuit life among the three groups (heparin, 20.9 hours; no anticoagulation, 19.3 hours; protamine, 21.2 hours; not significant). In conclusion, for a group of patients deemed to be at risk of bleeding, CVVH without anticoagulation achieved an acceptable circuit life, which was similar to that obtained in other patients with low dose heparin anticoagulation or regional anticoagulation with heparin/protamine.

Handling Continuous Renal Replacement Therapy-Related Adverse Effects in Intensive Care Unit Patients: The Dialytrauma Concept

“…When bleeding is a major issue, RRT without anticoagulation is feasible and safe. Circuit life time did not differ significantly when heparin (20.9 h), no anticoagulation (19.3 h) or protamine (21.2 h; p = 0.38) were compared and was similar to previously reported values for regional and nonregional anticoagulation [58]. …”

Regional Citrate Anticoagulation in Continuous Hemodialysis – Acid-Base and Electrolyte Balance at an Increased Dose of Dialysis

“…A variety of different anticoagulation protocols including the use of direct thrombin inhibitors [3], prostacyclin [4], low-molecular-weight heparins [5] or danaparoid [6] have not proven to be valid alternatives as they all are associated with important side effects including hemorrhages and/or vasodepression. A complete anticoagulation-free dialysis using saline flushes to prevent filter clotting has been suggested by different authors [7]. However, this is a time-demanding procedure which often yields only moderate filter lifetimes.…”

Continuous Renal Replacement Therapy and Anticoagulation:

“…The aPTT is monitored and typically maintained at 1.5 to 2.0 times normal. 1 In a study by Uchino et al, 22 however, the lifespan of the circuit with heparin did not differ significantly from the lifespan when no anticoagulant was used.…”

“…1,4,6,20 Heparin is inexpensive and easy to monitor, and its effects can be reversed with protamine. Studies 21,22 have indicated that the incidence of bleeding is greater with heparin administration than with other types of anticoagulation. Contraindications for the use of heparin include patient characteristics such as an intolerance to heparin, development of heparin-induced thrombocytopenia, and an increased chance of bleeding.…”