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In Vitro Thrombosis Test for Ventricular Assist Devices
Published on: March 21, 2025
Regional anticoagulation and antiaggregation for CVVH in critically ill patients: a prospective, randomized,
L P Fabbri1, M Nucera, M Al Malyan
1Department of Medical and Surgical Critical Care, Florence University, Florence, Italy.
Acta Anaesthesiologica Scandinavica
|August 5, 2009
Summary
Regional anticoagulation with heparin and prostacyclin during continuous veno-venous haemofiltration (CVVH) significantly improves filter lifespan and reduces circuit failure in acute renal failure patients. This method is safe and effective compared to systemic heparin alone.
Area of Science:
- Nephrology
- Intensive Care Medicine
- Critical Care
Background:
- Continuous veno-venous haemofiltration (CVVH) is crucial for critically ill patients with acute renal failure.
- Anticoagulation is essential for CVVH but can lead to complications.
- Optimizing anticoagulation strategies is vital for patient outcomes.
Purpose of the Study:
- To compare the efficacy and safety of regional anticoagulation with antiaggregation versus systemic anticoagulation in CVVH.
- To evaluate the impact on haemofilter performance and circuit lifespan.
- To assess clinical safety in critically ill patients with acute renal failure.
Main Methods:
- A prospective, controlled pilot study randomized 110 patients into two groups.
- Group 1 (G1) received regional anticoagulation (heparin + protamine) and antiaggregation (prostacyclin).
- Group 2 (G2) received only systemic heparin anticoagulation. Haemofilter transmembrane pressure (TMP), lifespan, and platelet count were monitored.
Main Results:
- Haemofilter TMP remained stable in G1, unlike G2 where it tripled (P=0.0002).
- Median filter lifespan was 68 hours in G1 versus 19 hours in G2.
- Spontaneous circuit failure occurred in 24% of G1 patients compared to 93% in G2 (P=0.0001). Platelet counts were stable in G1 and decreased in G2 (P=0.0073).
Conclusions:
- Regional anticoagulation with heparin, protamine, and prostacyclin is effective in CVVH for acute renal failure.
- This strategy prevents increased filter TMP and extends circuit lifespan.
- The procedure is simple, safe, and superior to systemic heparin anticoagulation alone.
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