Skip to main content
Log in

Continuous veno-venous hemofiltration without anticoagulation in high-risk patients

  • Original
  • Published:
Intensive Care Medicine Aims and scope Submit manuscript

Abstract

Objective: To study the safety and operative efficacy of continuous veno-venous hemofiltration (CVVH) without anticoagulation in patients at high risk of bleeding. Design: Prospective cohort study and comparison to control group. Setting: Tertiary, multidisciplinary intensive care unit. Patients: Forty hemofiltration circuits in 12 patients with severe acute renal failure (ARF) deemed at high risk of bleeding. Forty control circuits in 14 patients treated with low-dose pre-filter heparin infusion. Interventions: CVVH at 2 l/h of pump-controlled ultrafiltration without anticoagulation or saline flush in patients at high risk of bleeding. Collection of data at the bedside. Measurements and main results: Mean circuit life was 32 h (95% CI: 20–44.4) in patients receiving CVVH without anticoagulation. Forty-three per cent of filters lasted longer than 30 h. Circuit lifespan did not correlate with international normalized ratio (INR), activated partial thromboplastin time (APTT) or platelet count. There were no bleeding complications and azotemic control was not compromised by lack of circuit anticoagulation with a mean serum urea of 16.0 mmol/l (95% CI: 14.9–18.1) during treatment. A control group of consecutive similarly ill patients not at high risk of bleeding received low-dose pre-filter heparin (mean dose 716 IU; 95% CI: 647–785). Their mean filter life was 19.5 h (95% CI: 14.2–23.8), significantly shorter than in the study patients (p=0.017). Conclusions: Critically ill patients at high risk of bleeding who require continuous renal replacement therapy (CRRT) can be safely managed without circuit anticoagulation. This strategy minimizes bleeding risks and is associated with an acceptable filter life. CRRT without anticoagulation should be strongly considered in high-risk patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

Author information

Authors and Affiliations

Authors

Additional information

Final revision received: 28 July 2000

Electronic Publication

Rights and permissions

Reprints and permissions

About this article

Cite this article

Tan, H., Baldwin, I. & Bellomo, R. Continuous veno-venous hemofiltration without anticoagulation in high-risk patients. Intensive Care Med 26, 1652–1657 (2000). https://doi.org/10.1007/s001340000691

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s001340000691

Navigation