Epoprostenol (PGI2, Prostacyclin) During High‐Risk Hemodialysis: Preventing Further Bleeding Complications

Abstract

The frequency of hemodialysis-associated hemorrhage was studied prospectively in two successive, parallel, heparin-controlled studies using epoprostenol (PGI2; average dose, 4.1 ng/kg.min) as the sole antithrombotic agent. Sixty-three patients with active or recently active bleeding underwent 163 hemodialysis treatments in each of which prospective bleeding risk was assessed. PGI2 was associated with up to 50% overall reduction in the frequency of bleeding, particularly in the highest risk circumstances. PGI2 also allowed successful completion of the full, prospectively prescribed hemodialysis time in the most treatments (82% versus 93% with heparin). Furthermore, the efficiency of hemodialysis using PGI2, as indicated by the reduction in concentration of blood urea nitrogen and serum creatinine, was equal to that using heparin, even though there was a tendency toward modest reduction in residual volume of the hollow fiber dialyzer and slightly more frequent early termination of treatment from dialyzer clotting with PGI2. No severe vasodilatory side effects of PGI2 were observed during these studies. Hypotension was equally frequent during hemodialysis with heparin as with PGI2. The current results suggest that PGI2 should be considered as a substitute for heparin during high-risk hemodialysis because PGI2 may reduce the incidence of dialysis-associated bleeding without severe adverse side effects.

Contrast-induced acute kidney injury and renal support for acute kidney injury: a KDIGO summary (Part 2)

“…A small trial showed reduced bleeding complications compared with low-dose heparin, but at the expense of slightly more premature terminations [71]. Additional drawbacks are systemic hypotension and the high costs.…”

Hemodialysis without Systemic Anticoagulation: A Prospective Randomized Trial to Evaluate 3 Strategies in Patients at Risk of Bleeding

“…In these challenging cases, a variety of methods have been proposed 7 . Regional heparin/protamine [8], regional citrate/calcium [9]–[13] and prostacyclin [14], [15] are efficient but their use was limited by technical difficulties or clinical complications. Conversely, intermittent saline flushes (ISS) and constant saline infusion (CSI) of the circuit were described as simple and safe techniques to reduce clotting [7], [16], [17] and are widely used use in daily practice.…”

Controlled Study of Heparin versus Epoprostenol Sodium (Prostacyclin) as the Sole Anticoagulant for Chronic Hemodialysis

“…Although hypo tension, gastrointestinal complaints, flush ing and headaches were commonly ob served, dialyzer function was preserved, and there was no evidence of consumption coag ulopathy or increased destruction of RBC, WBC or platelets. Other short-term studies have shown similarly good results in patients dialyzing on hollow-fiber artificial kidneys [4,[6][7][8][9]12].…”

“…Our study shows that epopros tenol can provide satisfactory anticoagula tion for hemodialysis with acceptable levels of side effects. A comparative study of hepa rin versus epoprostenol has shown that epo prostenol will reduce hemorrhagic complica tions in patients at high risk for bleeding [6], Additional studies could determine whether epoprostenol anticoagulation is uniquely suitable for patients who cannot attain or tolerate high blood flows, patients with near normal hematocrits resulting from recombi nant erythropoietin therapy, patients with heparin-associated thrombocytopenia or pa tients dialyzing with recently developed high-efficiency or high-flux technologies. The true therapeutic niche of epoprostenol in clinical dialysis may not be identified un til this drug is released for general use to the nephrology community.…”