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Role of prostacyclin (epoprostenol) as anticoagulant in continuous renal replacement therapies: efficacy, security and cost analysis.
- Source :
-
Journal of nephrology [J Nephrol] 2006 Sep-Oct; Vol. 19 (5), pp. 648-55. - Publication Year :
- 2006
-
Abstract
- Background: Heparin remains the drug most commonly used for anticoagulation in continuous renal replacement therapies (CRRTs). However, in patients with hypercoagulability, heparin is insufficient or, in cases with an increased risk of bleeding or thrombocytopenia, it may be contraindicated. Epoprostenol, a potent vasodilator, antithrombotic and antiplatelet agent, could be an alternative.<br />Patients and Methods: We studied the records of patients treated under continuous venovenous hemodiafiltration in an academic tertiary hospital of 900 beds, between January 2000 and June 2003. Epoprostenol was prescribed to patients with (i) filter hypercoagulability, defined as consumption of 2 or more filters in the last 24 hours; (ii) low platelet count; or (iii) recent severe hemorrhage.<br />Results: Thirty-eight out of 248 (15%) patients who were under CRRT received epoprostenol for more than 72 hours. Epoprostenol was indicated due to filter hypercoagulability in 48%, thrombocytopenia in 68% (7 patients both) and hemorrhage in 3% of cases. The overall time for epoprostenol therapy was 9,749 hours. The mean filter duration previous to epoprostenol was 23 +/- 12 hours and after administering this drug 38.2 +/- 11.9 hours (p = 0.0001). In 6 patients, heparin and epoprostenol were simultaneously administered. The adverse effects were hemorrhage, which presented in 7 patients (18%) and a fall in blood pressure in another 7 (18%), which recovered in the next 24 hour after starting treatment. Cost analysis demonstrates some advantage with epoprostenol in patients with increased tendency to clotting.<br />Conclusions: Epoprostenol may be safely used to prevent clotting of the extracorporeal circuits, either alone in patients with thrombocytopenia and/or increased risk of bleeding, or in combination with heparin in states of hypercoagulability.
- Subjects :
- Anticoagulants administration & dosage
Anticoagulants adverse effects
Anticoagulants economics
Blood Pressure drug effects
Costs and Cost Analysis
Drug-Related Side Effects and Adverse Reactions
Epoprostenol adverse effects
Female
Hemorrhage blood
Hemorrhage economics
Hemorrhage prevention & control
Heparin administration & dosage
Heparin adverse effects
Heparin economics
Humans
Male
Platelet Aggregation Inhibitors adverse effects
Platelet Count
Renal Replacement Therapy adverse effects
Retrospective Studies
Risk Factors
Thrombocytopenia blood
Thrombocytopenia economics
Thrombocytopenia prevention & control
Thrombophilia blood
Thrombophilia economics
Thrombophilia therapy
Time Factors
Vasodilator Agents administration & dosage
Vasodilator Agents blood
Vasodilator Agents economics
Epoprostenol administration & dosage
Epoprostenol economics
Platelet Aggregation Inhibitors administration & dosage
Platelet Aggregation Inhibitors economics
Renal Replacement Therapy economics
Subjects
Details
- Language :
- English
- ISSN :
- 1121-8428
- Volume :
- 19
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- Journal of nephrology
- Publication Type :
- Academic Journal
- Accession number :
- 17136695