Clinical evaluation of hemofiltration without anticoagulation in critically ill patients at high risk of bleeding / 中国医学科学院学报

ABSTRACT

<p><b>OBJECTIVE</b>To explore the safety and therapeutic efficacy of hemofiltration without anticoagulation in critically ill patients at high risk of bleeding.</p><p><b>METHODS</b>We retrospectively analyzed 41 patients undergoing bedside hemofiltration in the Intensive Care Unit of PUMC Hospital from December 2005 to December 2006. The hemofiltration cases with or without anticoagulation were compared.</p><p><b>RESULTS</b>Totally 224 hemofiltration circuits were performed in these 41 patients, including 114 (50.89%) circuits without anticoagulation in 27 patients at high risk of bleeding and 110 (49.11%) with anticoagulation by heparin. The circuit life of hemofiltration without anticoagulation was (13.21 +/- 9.73) hours (3-55 hours), and that of hemofiltration with anticoagulation was (28. 35 +/- 26.43) hours (9-126) hours (P < 0.01). The circuit life had no correlation with prothrombin time (PT), activitated partial thromboplastin time (APTT), fibrinogen (Fbg), and platelet count (PLT) levels before the therapy (P > 0.05). The levels of blood creatinine, blood urea nitrogen, potassium, and pH value significantly improved after both therapies (P < 0.05). Urea reduction rates were (38.4 +/- 26.7)% and (24.3 +/- 13.2)% in hemofiltration with and without anticoagulation, respectively. The levels of Fbg and PLT significantly decreased after therapy in both groups (P < 0.01). PT and APTT did not change in hemofiltration without anticoagulation (P > 0.05), while APTIT was prolonged in hemofiltration with heparin (P < 0.01). Of the 21 patients who initially received hemofiltration with heparin, 7 patients turned to hemofiltration without anticoagulation for hemorrhagic complications. Seventeen (41.5%) of 41 patients died during hospital stay, but none of them died of complications of hemofiltration.</p><p><b>CONCLUSIONS</b>Hemofiltration without anticoagulation reduces bleeding risks and achieves an acceptable circuit life. The strategy can be applied as an alternative to critically ill patients at high risks of bleeding who need continuous blood purification.</p>