COMPARISON OF THE USE OF STANDARD HEPARIN AND PROSTACYCLIN ANTICOAGULATION IN SPONTANEOUS AND PUMP-DRIVEN EXTRACORPOREAL CIRCUITS IN PATIENTS WITH COMBINED ACUTE RENAL AND HEPATIC-FAILURE

Although prostacyclin has been reported to be an effective extracorpor eal anticoagulant for intermittent haemofiltration and dialysis treatm ents, it has been suggested that it is inferior to heparin in preventi ng clotting in spontaneously driven continuous haemofiltration and/or dialysis circuits. We studied the effectiveness of both heparin and pr ostacyclin as anticoagulants in a variety of extracorporeal circuits i n 17 patients with combined acute hepatic and renal failure who were a t risk of haemorrhage. Although there were no differences in the pump- assisted extracorporeal circuits, prostacyclin was found superior to h eparin during spontaneously driven continuous arteriovenous haemofiltr ation and/or dialysis. During some 2,600 h of prostacyclin therapy, th ere were only 3 episodes of haemorrhage that required blood transfusio n compared to 8 major haemorrhages and 2 deaths from intracerebral hae morrhage during 600 h of anticoagulation with heparin. The median filt er life was greater with prostacyclin, 60 h (42-72), compared to hepar in, 8 h (4-16), p < 0.01. This study suggests that prostacyclin is sup erior to heparin in maintaining the integrity of a spontaneous arterio venous extracorporeal circuit in patients at risk of major haemorrhage .