Background Patients with Acute Liver Failure (ALF) are pro-thrombotic and hence prone to circuit clotting leading to treatment downtimes on CRRT. In patients with ALF, heparin may either be contraindicated (thrombocytopenia) or insufficient (pro-coagulant). Epoprostenol, and an anti-platelet agent could be an alternative to heparin to prevent circuit clotting.
Aims To investigate efficacy and safety of Epoprostenol (synthetic prostacyclin analogue) as sole anti-haemostatic agent used for circuit patency during CRRT in patients with ALF.
MethodsProspective study of children with ALF admitted to PICU receiving CRRT over a 7 year period. Patients were stratified according to the used anticoagulant Epoprostenol PGI(2) group (n = 65) and non-epoprostenol group (n = 43). Efficacy was measured by filter life and mortality. Safety was assessed by number of bleeding episodes during CVVH, platelet consumption and hypotensive episodes (requirement for fluids/vasopressors).
Results 108 ALF patients underwent CRRT for a total of 17715 h utilising 587 filters (5,4 circuits/patient). Epoprostenol was used in 65 patients at the dose of 4 ng/kg/min administered pre-filter for a total of 8366 h. In the non-epoprostenol group 43 patients underwent CRRT for 8044 h using unfractionated heparin.
Median filter life was 32,7 h in Epoprostenol group and 24.9 h in non-epoprostenol group (p < 0.001). 14/65(21.5%) patients on Epoprostenol and 12/43(27.9%) in non-epoprostenol group experienced bleeding episodes. Platelet consumptions was significantly lower in epoprostenol group (527.3 ml versus 674 ml). Therapeutic intervention for hypotension was required in significantly lower CRRT sessions in Epoprostenol group (35.3% versus 41%). Despite higher PIM2 scores in Epoprostenol group (26.6 vs. 22.9), mortality was lower in this group (41%versus 53%)
Conclusions Epoprostenol as the sole anti-haemostatic agent for CRRT increases mean filter life, decreases bleeding risk without increasing risk of hypotension, platelet transfusion or mortality.