ANTICOAGULATION WITH PROSTAGLANDIN E-1 AND UNFRACTIONATED HEPARIN DURING CONTINUOUS VENOVENOUS HEMOFILTRATION

Objective: To determine the effect of two doses of prostaglan din E-1 (PGE(1), alprostadil) combined with unfractionated heparin on the hemo filter life-span and the coagulation profile during continuous venoven ous hemofiltration. Design: Prospective, randomized, controlled trial. Setting: Intensive care unit at a university-affiliated hospital. Pat ients: Twenty-four critically ill, mechanically ventilated patients wi th postoperative acute renal failure who require continuous venovenous hemofiltration. Interventions: The patients were anticoagulated with 5 ng/kg/min PGE, and 6 IU/kg/hr heparin or 20 ng/kg/min PGE, and 6 IU/ kg/hr heparin, injected into the extracorporeal circuit before the hem ofilter. Measurements and Main Results: The life-span of 43 hemofilter s was evaluated, They were used until extracorporeal line pressure exc eeded 250 mm Hg, ultrafiltration rate decreased to 16 ml/min, or gross ly visible extracorporeal clotting occurred, Blood was sampled from th e afferent (prefilter) and efferent (postfilter) lines of the extracor poreal circuit, Platelet counts, in vitro platelet function, plasma co ncentrations of platelet factor 4, prothrombin fragment F1+2, thrombin -antithrombin complex, routine plasma coagulation tests, and hemodynam ic profile were determined before and during hemofiltration, Hemofilte r usage was significantly longer in patients anticoagulated with 20 ng /kg/min PGE(1) (32 +/- 3 [SEM] hrs) than with 5 ng/kg/min PGE(1) (22 /- 3 hrs). In vitro bleeding parameters were significantly prolonged i n postfilter blood in patients receiving 20 ng/kg/min PGE(1.) Prefilte r, there was no antiplatelet activity in either group and platelet cou nts remained stable, No intra- or intergroup differences in plasma coa gulation profile or hemodynamic parameters were detected. Conclusion: Extracorporeal administration of PGE(1), combined with low-dose hepari nization, inhibits platelet reactivity and preserves hemofilter life d ose-dependently.