Real-World Safety and Circuit Outcomes of Protocolized Divided-Dose Enoxaparin During Continuous Renal Replacement...

Area of Science:

• Nephrology
• Critical Care Medicine
• Pharmacology

Background:

• Regional citrate anticoagulation (RCA) is preferred for continuous renal replacement therapy (CRRT) but requires specialized implementation.
• Limited evidence exists for low-molecular-weight heparin (LMWH) strategies without routine anti-Xa monitoring in CRRT.

Purpose of the Study:

• To evaluate the safety and efficacy of a standardized, divided-dose enoxaparin protocol for anticoagulation during CRRT.
• To assess circuit clotting and bleeding complications in patients receiving enoxaparin for CRRT.

Main Methods:

• Retrospective analysis of 200 adult ICU patients undergoing CRRT with a protocolized divided-dose enoxaparin regimen (1.5 mg/kg/24 h, prefilter doses every 4 h).
• Primary outcome: circuit clotting. Safety endpoints included ISTH major bleeding, clinically relevant non-major bleeding (CRNMB), minor bleeding, thrombosis, and heparin-induced thrombocytopenia (HIT).
• Competing risks analysis for death and hemodynamic instability.

Main Results:

• 223 CRRT runs contributed 8829.8 hours; median run duration was 35.0 hours.
• Circuit clotting occurred in 13.9% of runs (0.35 events/100 CRRT-hours).
• Any bleeding occurred in 4.5% of runs, including one ISTH major bleeding event and one CRNMB event. No thrombosis or HIT events were observed.

Conclusions:

• A standardized divided-dose enoxaparin protocol provides acceptable circuit performance and low bleeding rates in CRRT.
• This heparin-based strategy is a viable alternative in settings where regional citrate anticoagulation (RCA) is unavailable or not routinely used.
• Further prospective comparative studies are warranted to confirm these findings.