Prostacyclin versus citrate in continuous haemodiafiltration: An observational study in patients with high risk of bleeding
Abstract
The efficacy and safety of prostacyclin (PGI(2)) and citrate (ACD) anticoagulation were observed and compared during continuous haemodiafiltration. Methods: Mechanically ventilated patients received either the PGI(2) analogue epoprostenol (group A, n = 17) in escalating doses of 4.5 - 10.0 ng center dot kg(-1) center dot min(-1) in combination with heparin (6 IU center dot kg(-1) center dot h(-1)) or 2.2% ACD ( group B, n = 15).
Blood flow was set to match the circuit-filling volume per unit time equal to the intravascular half-life of PGI(2). Results: Median filter lifetimes were 26 h (interquartile range 16 - 37) in group A ( 39 filters) and 36.5 h ( interquartile range 23 - 50) in group B (56 filters; p < 0.01).
In group A, 4 patients (23.5%, p < 0.05) had the dose reduced due to hypotension. The final mean dose of PGI(2) was 8.7 +/- 2.4 ng center dot kg(-1) center dot min(-1).
Four patients in group A (23.5%, p < 0.05) were switched to ACD due to a decrease in platelet count. No bleeding episodes, decrease in platelet count or adverse haemodynamic effects were encountered in group B.
The cost of epoprostenol plus low dose heparin (EUR 204.73 +/- 53.04) was significantly higher than the cost of ACD-based anticoagulation (EUR 93.92 +/- 45.2, p < 0.05). Conclusion: ACD offers longer filter survival, has no impact on platelet count and is less expensive.
Increasing the dose of PGI(2) up to the average of 8.7 ng center dot kg(-1) center dot min(-1) did not increase the haemodynamic side effects.