Enoxaparin vs. unfractionated heparin for anticoagulation during continuous veno-venous hemofiltration: a randomized controlled crossover study
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- Joannidis, M., Kountchev, J., Rauchenzauner, M. et al. Intensive Care Med (2007) 33: 1571. doi:10.1007/s00134-007-0719-7
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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.
Prospective randomized controlled crossover study.
Medical and Surgical Intensive Care Unit of a University Hospital.
Forty consecutive adult medical and surgical ICU patients with normal anticoagulation parameters requiring CVVH.
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.
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.
Enoxaparin can be safely used for anticoagulation during CVVH resulting in higher filter lifespan compared with unfractionated heparin.