[Tracheobronchial injuries and fistulas]

This paper reviews the pathophysiological processes occurring after contact of blood with artificial surfaces during continuous haemofiltration and the predominant role of platelets in the genesis of extracorporeal thrombosis. A basic prerequisite for effective renal replacement therapy is adequate anticoagulation in order to inhibit activation of coagulation and to avoid haemofilter clotting. Antithrombotic regimens controlling plasma coagulation activation and platelet-surface interactions, as well as methods of coagulation monitoring are reviewed. In patients at risk for bleeding, combined antithrombotic regimens with short-acting antiaggregatory prostaglandins and unfractionated or fractionated heparin were more effective in reducing bleeding complications and morbidity during and after haemofiltration then heparinisation alone. Heparinoids and hirudine are indicated in patients with heparin-induced thrombocytopenia II. In patients at risk for thromboembolism, regional citrate anticoagulation may be beneficial. Performing continuous haemofiltration without antithrombotic therapy is not recommended.