Analysis of anticoagulation therapy for critical care haemofiltration patients

Introduction In 2008, an anticoagulation protocol was introduced into the critical care unit at Sandwell Hospital. The protocol indicates heparin as the first line anticoagulant treatment and provides guidance on appropriate infusion rates based on the patient’s Activated Partial Thromboplastin Time ratio (APTTr). The aim of this study was to assess if anticoagulant use in haemofiltration patients in critical care adhered to the protocol, for both choice and dose changes and to assess the number of filters used per patient, the filter survival rate and the reasons for filter change.
Materials & Methods Design: Retrospective audit of haemofiltration therapy of twenty-two critical care patients from 2010.
Setting: Critical care unit, Sandwell Hospital, UK.
Main outcome measures: Duration of CVVH therapy, anticoagulant administered, number of filter changes, duration of filter usage and level of protocol adherence.
Results: 86% (n = 19/22) of patients were prescribed heparin in accordance with the protocol, 9% (n = 2/22) were prescribed epoprostenol and 5% (n = 1/22) had no anticoagulant administered. Of those patients who received heparin, 91% (n = 70/77) of infusion rate changes were adjusted appropriately, in accordance with the protocol. The protocol was followed completely for 63% (n = 12/19) of the patients receiving heparin. A total of 48 filter changes occurred, half of these (50%; n = 24/48) were due to clotting, 35% (n = 17/48) due to wash-back, 8% (n = 4/48) due to increased pressure, 4% (n = 2/48) due to air trap and 2% (n  1/48) due to vascular access problems. The mean filter life was 21 h (range 0.6–81 h)—it was not possible, due to low numbers, to see if the choice of anticoagulant affected the filter survival rate.
Discussions, Conclusion: The majority of anticoagulation administration adhered to the protocol; however, some variation in adherence to the heparin protocol was observed. By emphasising the importance of APTTr measurements to indicate the heparin infusion rate adjustment required, it is hoped that further optimisation of critical care haemofiltration at Sandwell Hospital can occur.
Disclosure of Interest: None Declared