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01.09.2007 | Original

Enoxaparin vs. unfractionated heparin for anticoagulation during continuous veno-venous hemofiltration: a randomized controlled crossover study

verfasst von: Michael Joannidis, Jordan Kountchev, Markus Rauchenzauner, Nicola Schusterschitz, Hanno Ulmer, Andreas Mayr, Romuald Bellmann

Erschienen in: Intensive Care Medicine | Ausgabe 9/2007

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Abstract

Objective

The purpose of this study was to evaluate the efficacy and safety of the low molecular weight heparin enoxaparin as anticoagulant in continuous veno-venous hemofiltration (CVVH) compared with unfractionated heparin.

Design

Prospective randomized controlled crossover study.

Setting

Medical and Surgical Intensive Care Unit of a University Hospital.

Patients

Forty consecutive adult medical and surgical ICU patients with normal anticoagulation parameters requiring CVVH.

Intervention

CVVH was performed with pre-filter fluid replacement at 2500 ml/h and blood flow rates of 180 ml/min. Heparin-treated patients received an initial pre-filter bolus of 30 IU/kg and a maintenance infusion at 7 units/kg h⁻¹, titrated to achieve a systemic activated partial thromboplastin time (aPTT) of 40–45 s. Enoxaparin-treated patients received an initial pre-filter bolus of 0.15 mg/kg and a maintenance infusion starting at 0.05 mg/kg h⁻¹, which was subsequently adjusted to maintain systemic anti-factor Xa activity (anti-Xa) at 0.25–0.30 IU/ml. Each patient received both regimens in a crossover design. Maximum treatment duration for each set was 72 h.

Results

Patients included had a mean APACHE II score of 22 (10–35). Thirty-seven patients completed both study arms. Mean filter life span was 21.7 h (± 16.9 h) for heparin and 30.6 h (± 25.3) for enoxaparin (p = 0.017, ANOVA for repeated measures). One major bleeding episode occurred during heparin as well as during enoxaparin treatment. Cost analysis showed average daily costs of 270 and 240 € for heparin and enoxaparin, respectively.

Conclusion

Enoxaparin can be safely used for anticoagulation during CVVH resulting in higher filter lifespan compared with unfractionated heparin.

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Titel: Enoxaparin vs. unfractionated heparin for anticoagulation during continuous veno-venous hemofiltration: a randomized controlled crossover study
verfasst von: Michael Joannidis
Jordan Kountchev
Markus Rauchenzauner
Nicola Schusterschitz
Hanno Ulmer
Andreas Mayr
Romuald Bellmann
Publikationsdatum: 01.09.2007
Verlag: Springer-Verlag
Erschienen in: Intensive Care Medicine / Ausgabe 9/2007
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-007-0719-7

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Enoxaparin vs. unfractionated heparin for anticoagulation during continuous veno-venous hemofiltration: a randomized controlled crossover study