A pilot randomized controlled crossover study comparing regional heparinization to regional citrate anticoagulation for continuous venovenous hemofiltration

Objective: To evaluate the efficacy and safety of a regional heparinization and a regional citrate method of anticoagulation in CVVH. Design: Randomized controlled cross-over study. Subjects: Ten critically ill patients with acute renal failure. Setting: ICU of tertiary hospital. Intervention: CVVH was performed with pre-filter fluid replacement at 2000ml/h and a blood flow rate of 150ml/min. Regional heparinization was by the administration of heparin pre-filter at 1500lU/h and protamine post-filter at 15mg/h. Regional citrate anticoagulation was by means of a citrate-based replacement fluid (14 mmol/L) administered pre-dilution. Results: We studied nine males and one female. The mean age and APACHE II score were 70.5 and 17 respectively. Median circuit life was 13 hours (IQR 9.28) for the regional heparinization method compared to 17 hours (IQR 12, 19.5) for the regional citrate method (p=0.77). There were no episodes of bleeding in either group. Conclusion: Regional heparinization and regional citrate anticoagulation achieve similar circuit life in critically ill patients receiving CVVH.