Acquired deficit of antithrombin and role of supplementation in septic patients during continuous veno-venous hemofiltration

ASAIO Journal : a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Mathieu LafargueGérard Janvier

Abstract

Continuous renal replacement therapy (CRRT) is widely used in the management of septic patients with acute renal failure (ARF). Short filter lifespan (<24 hours) is a major concern and may result of a procoagulating state. The aim of this study was to investigate the relationship between antithrombin (AT) deficit and early filter clotting, and whether supplementation of AT could increase filter lifespan. Two different methods for supplementation, bolus and continuous infusion were also compared. We conducted a two-center prospective study from March 2003 to May 2004. Twenty-seven patients with septic shock and ARF were included and treated by CRRT. Unfractionated heparin (UHF) was used for anticoagulation. The initial level of AT was low with a median level at 45.4% (16%-69%). Low AT activity was associated with shorter filter lifespan. Supplementation led to a longer filter lifespan (15.2-33.2 hours) (p < 0.05). Continuous infusion provided better results: 48.5 vs. 27.8 hours for bolus method. This study suggests that AT measurement should be considered in continuous veno-venous hemofiltration with clotting problems as supplementation could increase filter lifespan by more than 100%. Continuous infusion is preferable. Cost eff...Continue Reading

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Citations

Dec 5, 2009·Critical Care : the Official Journal of the Critical Care Forum·Heleen M Oudemans-van StraatenAnja Leyte
Jun 18, 2009·Medizinische Klinik·Norbert Maurin
Oct 11, 2013·Therapeutic Apheresis and Dialysis : Official Peer-reviewed Journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy·Janis Rebecca BedarfJuliane Katharina Unger
Mar 13, 2020·The Cochrane Database of Systematic Reviews·Hiraku TsujimotoYuki Kataoka
Dec 15, 2020·The Cochrane Database of Systematic Reviews·Hiraku TsujimotoYuki Kataoka

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