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Premature circuit clotting is a major problem during continuous venovenous haemofiltration (CVVH). Some studies have suggested that circuit life can be improved by adding epoprostenol to heparin.
Retrospective review of mean circuit patency in patients on noncitrate-based anticoagulation regimens during CVVH in a 30-bed multidisciplinary ICU between October 2008 and May 2009. Circuits which were discontinued electively were excluded from the analysis.
Patency data were available for 486 noncitrate circuits. There was no significant difference in mean circuit life between heparin given via circuit (n = 169 circuits; mean circuit life 19.8 hours) and epoprostenol alone (n = 119 circuits; mean circuit life 20.9 hours). In a small group of patients on heparin via the circuit, epoprostenol was added for patency reasons (n = 19 circuits). In this group, the mean circuit life was only 15 hours. Circuits of patients on systemic heparin (n = 100) lasted for a mean of 23.5 hours. In a small group of patients, epoprostenol was added via the circuit (n = 32 circuits). The mean circuit life was 28.9 hours (P > 0.05). Other types of noncitrate anticoagulation were activated protein C and lepuridin, alone or in combination with heparin (n = 47 circuits).
In our practice, anticoagulation with epoprostenol alone led to similar circuit survival as heparin administered via the circuit. Adding epoprostenol to heparin did not significantly prolong the mean circuit life. Further analysis of circuit patency in individual patients is needed to determine the characteristics of patients who may benefit and for whom the extra cost could be justified.