Antithrombin III Deficiency during Continuous Venovenous Hemodialysis

Bastien, O.; French, Paul; Paulus, Sara; Filley, S.; Berruyer, Micheline; Dechavanne, M; Estanove, S

doi:10.1159/000424631

Cited by 17 publications

(8 citation statements)

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“…Other proteins involved in the regulation of coagulation such as activated protein C are also de®cient in critical illness (20) making the laboratory assessment of in vivo coagulability even more dicult. Furthermore, many patients with multi-organ failure have de®ciencies of antithrombin III, the co-factor for heparin (21). In these patients, therefore, the dose of heparin is unlikely to provide a guide to the likelihood of ®lter clotting.…”

Section: Discussionmentioning

confidence: 99%

A Prospective Study of Thromboelastography (Teg) and Filter Life During Continuous Veno-Venous Hemofiltration

et al. 2000

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Anticoagulants are commonly used to prolong circuit life during continuous hemofiltration. However, a clear correlation between routinely performed blood coagulability tests and circuit life has not been demonstrated. This lack of correlation may derive from the limited ability of such tests to describe the likelihood of in vivo clotting. We hypothesized that thromboelastography (TEG), which derives its variables from a closer reproduction of in vivo coagulation, would significantly correlate with filter life. Accordingly, we conducted a prospective pilot study of the correlation between filter life and TEG-derived variables in 21 hemofilters used in 6 critically ill patients admitted to a tertiary intensive care unit. It involved the performance of TEG during steady state anticoagulation, measurement of circuit life, and of routine coagulation variables. The results showed that the mean circuit life was 20.7+/-4.0 h despite an average aPTT of 67.7+/-12.8 s and a mean heparin dose of 472.5+/-96.2 IU/h. The mean INR was 1.4+/-1 and the mean platelet count was 118+/-16 x 10(3)/mm3. Although several TEG variables correlated with heparin dose (p < 0.03), no correlation was found between any of the routine coagulation variables or any of the TEG variables and circuit life. In conclusion, no significant correlation between TEG derived variables or routinely measured coagulation variables and circuit life could be demonstrated. These findings suggest that such tests are not useful indicators of circuit anticoagulation adequacy and that factors other than blood coagulability may play a role in circuit failure.

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Section: Discussionmentioning

confidence: 99%

A Prospective Study of Thromboelastography (Teg) and Filter Life During Continuous Veno-Venous Hemofiltration

et al. 2000

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“…18,19 Critically ill patients may also have acquired antithrombin III (antithrombin) deficiency, making them more resistant to the anticoagulant effects of heparin. 20,21 Heparin is an appropriate agent for most patients; however, alternative anticoagulants are needed for critically ill patients who are not candidates for heparin therapy or are unable to achieve target end points with conventional heparin therapy.…”

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confidence: 99%

Bivalirudin versus Unfractionated Heparin for Prevention of Hemofilter Occlusion During Continuous Renal Replacement Therapy

et al. 2010

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“…7,17,18 A postdialysis rate reduction by consumption of platelets and AT has also been described, 6,19 as well as a correlation between this reduced rate and circuit clotting. 20 Bastien et al, 21,22 studying early circuit clotting in 25 hemofiltrated patients who had undergone cardiovascular surgery, found a 50% increase in filter clotting with an AT rate Ͻ70%. These findings were recently confirmed in an experimental study by Shulman et al 23 who managed to obtain a longer filter lifespan after fresh frozen plasma supplementation.…”

Section: Discussionmentioning

confidence: 99%

Acquired Deficit of Antithrombin and Role of Supplementation in Septic Patients During Continuous Veno-Venous Hemofiltration

Lafargue¹,

Joannès-Boyau²,

Honoré³

et al. 2008

ASAIO Journal

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Continuous renal replacement therapy (CRRT) is widely used in the management of septic patients with acute renal failure (ARF). Short filter lifespan (<24 hours) is a major concern and may result of a procoagulating state. The aim of this study was to investigate the relationship between antithrombin (AT) deficit and early filter clotting, and whether supplementation of AT could increase filter lifespan. Two different methods for supplementation, bolus and continuous infusion were also compared. We conducted a two-center prospective study from March 2003 to May 2004. Twenty-seven patients with septic shock and ARF were included and treated by CRRT. Unfractionated heparin (UHF) was used for anticoagulation. The initial level of AT was low with a median level at 45.4% (16%-69%). Low AT activity was associated with shorter filter lifespan. Supplementation led to a longer filter lifespan (15.2-33.2 hours) (p < 0.05). Continuous infusion provided better results: 48.5 vs. 27.8 hours for bolus method. This study suggests that AT measurement should be considered in continuous veno-venous hemofiltration with clotting problems as supplementation could increase filter lifespan by more than 100%. Continuous infusion is preferable. Cost effectiveness should be evaluated shortly.

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Antithrombin III Deficiency during Continuous Venovenous Hemodialysis

Cited by 17 publications

References 0 publications

A Prospective Study of Thromboelastography (Teg) and Filter Life During Continuous Veno-Venous Hemofiltration

A Prospective Study of Thromboelastography (Teg) and Filter Life During Continuous Veno-Venous Hemofiltration

Bivalirudin versus Unfractionated Heparin for Prevention of Hemofilter Occlusion During Continuous Renal Replacement Therapy

Acquired Deficit of Antithrombin and Role of Supplementation in Septic Patients During Continuous Veno-Venous Hemofiltration

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