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Research paper
Published online: 2020-03-18
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Filter life span in postoperative cardiovascular surgery patients requiring continuous renal replacement therapy, using a post dilution regional citrate anticoagulation continuous hemofiltration circuit

Agnieszka Kośka, Christopher J. Kirwan, Maciej M. Kowalik, Anna Lango-Maziarz, Wiktor Szymanowicz, Dariusz Jagielak, Romuald Lango
DOI: 10.5603/CJ.a2020.0039
·
Pubmed: 32207837

open access

Ahead of print
Original articles
Published online: 2020-03-18

Abstract

Background: Regional citrate anticoagulation (RCA) is the recommended standard for continuous renal replacement therapy (CRRT). This study assesses its efficacy in patients admitted to critical care following cardiovascular surgery and the influence of standard antithrombotic agents routinely used in this specific group.

Methods: Consecutive cardiovascular surgery patients treated with post-dilution hemofiltration with RCA were included in this prospective observational study. The primary outcome of the study was CRRT circuit life-span adjusted for reasons other than clotting. The secondary outcome evaluated the influence of standard antithrombotic agents (acetylsalicylic acid [ASA], low molecular weight heparin [LMWH] or fondaparinux as thromboprophylaxis or treatment dose with or without ASA) on filter life.

Results: Fifty-two patients underwent 193 sessions of CVVH, after exclusion of 15 sessions where unfractionated heparin was administered. The median filter life span was 58 hours. Filter life span was significantly longer in patients receiving therapeutic dose of LMWH or fondaparinux (79 h [2–110]), in comparison to patients treated with prophylactic dose of LMWH or fondaparinux (51 h [7–117], p < 0.001), and patients without antithrombotic prophylaxis (42 h [2–91], p < 0.0001). 12 bleeding episodes were observed; 8 occurred in patients receiving treatment dose anticoagulation, 3 in patients receiving prophylactic dose anticoagulation and 1 in a patient with no antithrombotic prophylaxis.

Conclusions: A post dilution hemofiltration with RCA provides prolonged filter life span when adjusted for reasons other than clotting. Patients receiving treatment dose anticoagulation had a significantly longer filter life span than those who were on prophylactic doses or ASA alone.

Abstract

Background: Regional citrate anticoagulation (RCA) is the recommended standard for continuous renal replacement therapy (CRRT). This study assesses its efficacy in patients admitted to critical care following cardiovascular surgery and the influence of standard antithrombotic agents routinely used in this specific group.

Methods: Consecutive cardiovascular surgery patients treated with post-dilution hemofiltration with RCA were included in this prospective observational study. The primary outcome of the study was CRRT circuit life-span adjusted for reasons other than clotting. The secondary outcome evaluated the influence of standard antithrombotic agents (acetylsalicylic acid [ASA], low molecular weight heparin [LMWH] or fondaparinux as thromboprophylaxis or treatment dose with or without ASA) on filter life.

Results: Fifty-two patients underwent 193 sessions of CVVH, after exclusion of 15 sessions where unfractionated heparin was administered. The median filter life span was 58 hours. Filter life span was significantly longer in patients receiving therapeutic dose of LMWH or fondaparinux (79 h [2–110]), in comparison to patients treated with prophylactic dose of LMWH or fondaparinux (51 h [7–117], p < 0.001), and patients without antithrombotic prophylaxis (42 h [2–91], p < 0.0001). 12 bleeding episodes were observed; 8 occurred in patients receiving treatment dose anticoagulation, 3 in patients receiving prophylactic dose anticoagulation and 1 in a patient with no antithrombotic prophylaxis.

Conclusions: A post dilution hemofiltration with RCA provides prolonged filter life span when adjusted for reasons other than clotting. Patients receiving treatment dose anticoagulation had a significantly longer filter life span than those who were on prophylactic doses or ASA alone.

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Keywords

cardiovascular surgical procedures, continuous renal replacement therapy, hemofiltration, anticoagulants, citric acid

About this article
Title

Filter life span in postoperative cardiovascular surgery patients requiring continuous renal replacement therapy, using a post dilution regional citrate anticoagulation continuous hemofiltration circuit

Journal

Cardiology Journal

Issue

Ahead of print

Article type

Research paper

Published online

2020-03-18

DOI

10.5603/CJ.a2020.0039

Pubmed

32207837

Keywords

cardiovascular surgical procedures
continuous renal replacement therapy
hemofiltration
anticoagulants
citric acid

Authors

Agnieszka Kośka
Christopher J. Kirwan
Maciej M. Kowalik
Anna Lango-Maziarz
Wiktor Szymanowicz
Dariusz Jagielak
Romuald Lango

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