Tuesday December 30, 2008
Is Xigris safe with anticoagulation of CVVHD?

Drotrecogin alfa is use for the treatment of severe sepsis with multiple organ failure. Patients with severe sepsis on renal replacement therapy (RRT), who typically receive additional anticoagulation to prevent circuit clotting, may be at higher risk of bleeding. The aim of this study was to analyse the filter survival time (FST), and to quantify the requirement of packed red cells (PRC) and blood products during xigris infusion.

Methods: This was a single-centre, retrospective observational study conducted in an adult intensive care unit (ICU). Thirty-five patients with severe sepsis who had received both RRT and Drotrecogin alfa were identified.

Results

• The proportion of filter changes due to filter clotting was similar during Drotrecogin alfa infusion and with conventional anticoagulation Drotrecogin alfa infusion. There was no difference in the Filter survival time(FST) and filter parameters during Drotrecogin alfa in the presence or absence of additional anticoagulation with heparin or epoprostenol.
• A similar proportion of patients required red cell transfusion, although a greater proportion of patients received platelet and fresh frozen plasma (FFP) during Drotrecogin alfa infusion compared to the Drotrecogin alfa period with no difference between medical and surgical patients.

Conclusions: Additional anticoagulation during Drotrecogin alfa infusion does not appear to improve Filter Survival Time (FST). The use of Drotrecogin alfa in patients with severe sepsis requiring RRT is safe and is not associated with an increased need for PRC transfusion or major bleeding events.



Reference: click to get abstract

Filter survival time and blood products requirement in patients with severe sepsis receiving drotrecogin alfa (activated) and requiring renal replacement therapy Critical Care 2008, 12:R163 (18 December 2008)