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Die Highlights vom Kongress des American College of Cardiology 2024

Im April diskutierten die Herz-Kreislauf-Spezialisten aus der ganzen Welt auf dem  Kongress des American College of Cardiology (ACC) u.a. neue Therapieansätze bei akutem Myokardinfarkt, koronarer Herzerkrankung, kardiogenem Schock oder Aortenklappenstenose. In unserem Kongress-Dossier haben wir für Sie Berichte über die „Late-Breaking Trials“ und andere wichtige Studien zusammengestellt. 
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Intensive Care Medicine
Erschienen in: Intensive Care Medicine 2/2006

01.02.2006 | Review

Anticoagulation strategies in continuous renal replacement therapy: can the choice be evidence based?

verfasst von: H. M. Oudemans-van Straaten, J. P. J. Wester, A. C. J. M. de Pont, M. R. C. Schetz

Erschienen in: Intensive Care Medicine | Ausgabe 2/2006

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Abstract

Objectives

Critical illness increases the tendency to both coagulation and bleeding, complicating anticoagulation for continuous renal replacement therapy (CRRT). We analyzed strategies for anticoagulation in CRRT concerning implementation, efficacy and safety to provide evidence-based recommendations for clinical practice.

Methods

We carried out a systematic review of the literature published before June 2005. Studies were rated at five levels to create recommendation grades from A to E, A being the highest. Grades are labeled with minus if the study design was limited by size or comparability of groups. Data extracted were those on implementation, efficacy (circuit survival), safety (bleeding) and monitoring of anticoagulation.

Results

Due to the quality of the studies recommendation grades are low. If bleeding risk is not increased, unfractionated heparin (activated partial thromboplastin time, APTT, 1–1.4 times normal) or low molecular weight heparin (anti-Xa 0.25–0.35 IU/l) are recommended (grade E). If facilities are adequate, regional anticoagulation with citrate may be preferred (grade C). If bleeding risk is increased, anticoagulation with citrate is recommended (grade D−). CRRT without anticoagulation can be considered when coagulopathy is present (grade D−). If clotting tendency is increased predilution or the addition of prostaglandins to heparin may be helpful (grade C−).

Conclusion

Anticoagulation for CRRT must be tailored to patient characteristics and local facilities. The implementation of regional anticoagulation with citrate is worthwhile to reduce bleeding risk. Future trials should be randomized and should have sufficient power and well defined endpoints to compensate for the complexity of critical illness-related pro- and anticoagulant forces. An international consensus to define clinical endpoints is advocated.
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Metadaten
Titel
Anticoagulation strategies in continuous renal replacement therapy: can the choice be evidence based?
verfasst von
H. M. Oudemans-van Straaten
J. P. J. Wester
A. C. J. M. de Pont
M. R. C. Schetz
Publikationsdatum
01.02.2006
Verlag
Springer-Verlag
Erschienen in
Intensive Care Medicine / Ausgabe 2/2006
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-005-0044-y

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