Preliminary report of an enoxaparin dose protocol based on anti-Xa activity in continuous renal replacement therapy
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KeywordsEnoxaparin Unfractionated Heparin Continuous Renal Replacement Therapy Gastric Lesion Filter Performance
During continuous renal replacement therapy (CRRT), anticoagulation of the extracorporeal circuit is generally required to prevent clotting of the circuit, preserve filter performance, optimize circuit survival, and prevent blood loss due to circuit clotting. Unfractionated heparin and low-molecular-weight heparin are generally used to perform this strategy. This anticoagulation may cause dangerous bleeding, however, especially in acute renal critical patients. In these patients, it is very difficult to predict bleeding or thrombosis correctly during CRRT.
To asses the safety and efficacy of the use of an enoxaparin dose protocol based on anti-Xa activity in CRRT.
From September 2005 to December 2006, 26 patients were submitted to 55 CRRT sessions. All sessions used an enoxparin dose protocol based on anti-Xa activity (target 0.25–0.4 U/ml). The endpoints analyzed were the circuit time (hours) to judge efficacy, and death (30-day mortality) and serious bleeding (red cell transfusion) to judge safety.
Continuous veno-venous hemodiafiltration was a frequently used method in 53 sessions (96.4%). The average circuit time was 41.6 ± 26.6 hours. Ten patients received red blood transfusion (19 transfusions required) related to CRRT and four patients had bleeding complications (retroperitoneal hemorrhage, hemothorax, puncture complication, acute gastric lesion). No death was reported during 30 days of follow-up.
In this series, the use of an enoxaparin dose protocol based on anti-Xa activity in CRRT was considered relatively safe and effective. The circuit time of 41 hours was acceptable in effectiveness and efficiency.