Use of a low-molecular-weight heparinoid (danaparoid sodium) for continuous renal replacement therapy in intensive care patients

The purpose of this study was to evaluate the efficacy and safety of danapa roid in the treatment of critically ill patients with acute renal failure a nd suspected heparin-induced thrombocytopenia (HIT) needing renal replaceme nt therapy (RRT). We conducted a retrospective analysis of 13 consecutive i ntensive care patients with acute renal failure and suspected HIT who were treated with danaparoid for at least 3 days during RRT. In eight patients, continuous venovenous hemofiltration was performed. The mean infusion rate of danaparoid was 140 +/- 86 U/hour. Filter exchange was necessary every 37 .5 hours. In five patients, continuous venovenous hemodialysis was used. A bolus injection of 750 U danaparoid was followed by a mean infusion rate of 138 +/- 122 U/hour. Filters were exchanged every 24 hours. In 7 of 13 pati ents. even a low mean infusion rate of 88 +/- 35 U/hour was efficient. Mean anti-Xa (aXa) levels were approximately 0.4 +/- 0.2 aXa U/mL. Persistent t hrombocytopenia despite discontinuation of heparin treatment was observed i n 9 of 13 patients, owing to disseminated intravascular coagulation (DIC). HIT was confirmed by an increase in platelet count and positive heparin-ind uced antibodies in 2 of 13 patients. No thromboembolic complications occur- red, but major bleeding was observed in 6 of 13 patients, which could be ex plained by consumption of coagulation factors and platelets due to DIC in 5 of 6 patients. Nine of 13 patients died of multiorgan failure or sepsis, o r both. In none of these patients was the fatal outcome related to danaparo id treatment. In critically ill patients with renal impairment and suspecte d HIT, a bolus injection of 750 U danaparoid followed by a mean infusion ra te of 50 to 150 U/hour appears to be a safe and efficient treatment option when alternative anticoagulation is necessary.