ORIGINAL ARTICLES  CRITICAL CARE Free access

Minerva Anestesiologica 2003 June;69(6):527-38

Copyright © 2003 EDIZIONI MINERVA MEDICA

language: English, Italian

Regional filter heparinization for continuous veno-venous hemofiltration in liver transplant recipients

Biancofiore G., Esposito M., Bindi L., Stefanini A., Bisà M., Boldrini A., Consani G., Filipponi F. ¹, Mosca F. ²

Post-surgical and Transplant Intensive Care Unit, 1st Department of Anaesthesia and Intensive Care, Cisanello Hospital, Pisa, Italy 1 Liver Transplant Unit, University School of Medicine, Cisanello Hospital, Pisa, Italy 2 General and Transplantation Surgery University School of Medicine Cisanello Hospital, Pisa, Italy

Aim. To ­study safe­ty, clin­i­cal and oper­a­tive fea­sibil­ity of con­tin­u­ous ­veno-­venous hemo­fil­tra­tion (­CVVH) ­with anti­co­ag­u­la­tion ­only of the fil­ter in ­patients at ­risk for bleed­ing.
Methods. This pros­pec­tive, com­par­a­tive, non ran­dom­ised ­study was com­plet­ed at an inten­sive ­care ­unit of a teach­ing NHS hos­pi­tal. Sixteen liv­er trans­plant (LT) recip­ients ­with ­acute ­renal fail­ure need­ing ­CVVH ­were treat­ed ­with a region­al anti­co­ag­u­la­tion pro­to­col (hep­ar­in and pro­ta­mine ­were admin­is­tered respec­tive­ly pre- and ­post-fil­ter) and com­pared to 11 crit­i­cal­ly ill sub­jects who ­received a stan­dard low-hep­ar­in treat­ment. Activated coag­u­la­tion ­time (ACT) mon­i­tor­ing was ­used to ­adjust anti­co­ag­u­la­tion and hep­ar­in neu­tral­iza­tion.
Results. Mean cir­cuit ­life was 35.8±13.6 ­hours (95% CI 28.5-43.1) in ­patients receiv­ing region­al anti­co­ag­u­la­tion and 34.4±14 ­hours in con­trols (95% CI 25.5-43.3; p=0.7). Fourty-­eight cir­cuits (47.5% of the ­total) in the hep­ar­in-pro­ta­mine ­group had a ­life-­span long­er ­than 30 ­hours and oth­er 22 (21.7%) ­were ­changed inten­tion­al­ly ­after 24 ­hours of use in ­absence of ­clots. None of the ­patients in ­both the stud­ied ­groups had bleed­ing or hemo­dy­nam­ic com­pli­ca­tions and ­their azo­tem­ic con­trol was ­always sat­is­fac­to­ry.
Conclusion. In LT recip­ients, region­al anti­co­ag­u­la­tion can ­achieve a cir­cuits ­life-­span com­par­able to ­that ­from system­ic anti­co­ag­u­la­tion ­with sat­is­fac­to­ry safe­ty and sim­plic­ity of use.