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Conventional coagulation and thromboelastograph parameters and longevity of continuous renal replacement circuits
Andrew W Holt1, Petra Bierer, Paul Glover
1Department of Critical Care Medicine, Flinders Medical Centre, Flinders University of South Australia, Bedford Park, Adelaide. andrew.holt@fmc.sa.gov.au
Intensive Care Medicine
|November 5, 2002
Summary
Thromboelastography (TEG) and conventional coagulation tests predict continuous renal replacement therapy (CRRT) circuit longevity. However, TEG monitoring offers minimal clinical benefit for CRRT anticoagulation despite closer prediction of circuit life.
Area of Science:
- Nephrology
- Critical Care Medicine
- Hematology
Background:
- Continuous renal replacement therapy (CRRT) is vital for critically ill patients with kidney failure.
- Circuit longevity in CRRT is often limited by clotting, necessitating effective anticoagulation strategies.
Purpose of the Study:
- To investigate the relationship between conventional coagulation parameters and thromboelastography (TEG) variables with CRRT circuit longevity.
- To assess the predictive value of these parameters for circuit failure due to clotting.
Main Methods:
- A prospective study involving 14 patients undergoing continuous veno-venous haemodialysis (CVVH).
- Conventional coagulation tests (INR, APTT) and TEG parameters were measured at the start and during CRRT.
- Circuit longevity was determined by the time to clotting, identified by a pressure gradient rise across the haemofilter.
Main Results:
- Forty-seven circuits were analyzed, with a mean circuit life of 33.0 hours.
- Twenty-five circuits failed due to clotting, with a mean life of 30.8 hours.
- Activated partial thromboplastin time (APTT) and TEG variables (reaction time R, coagulation time RK) correlated with circuit longevity. Heparin anticoagulation significantly prolonged circuit life.
Conclusions:
- TEG variables demonstrated a stronger correlation with CRRT circuit longevity compared to conventional coagulation tests.
- Despite predictive capabilities, the clinical utility of TEG for guiding CRRT anticoagulation appears limited.
- Further research may be needed to optimize anticoagulation monitoring in CRRT circuits.