Intermittent versus continuous enoxaparine for anticoagulation during continuous venovenous hemofiltration

Introduction

The exact dosage of anticoagulation during continuous venovenous hemofiltration (CVVH) is crucial for maximal effect and safety of the procedure. Enoxaparine is one possible choice of anticoagulant drug. The aim of our study was to compare the mean dose of enoxaparine depending on whether a bolus or continuous administration scheme was used.

Methods

We performed retrospective analysis of prospectively collected data for 36 consecutive patients (24 male and 12 female) receiving CVVH in the ICU of East Tallinn Central Hospital. Twenty-three patients received boluses of enoxaparine every 6 hours, and 13 patients received continuous infusion of enoxaparine. The dosage of anticoagulation was guided according to the results of anti-Xa measurements.

Results

The mean age of the patients (61.4 ± 15.7 years) and the mean duration of the procedure (76.2 ± 29.2 hours) did not differ significantly between the two groups. The mean dose of enoxaparine was 0.12 ± 0.05 mg/kg/hour in the bolus group and 0.08 ± 0.03 mg/kg/hour in the continuous group (P = 0.027). The mean anti-Xa did not differ significantly between the groups (1.03 ± 0.42 vs 0.88 ± 0.24 units/ml, respectively, P = 0.252). Filter clotting was observed 0.39 ± 0.58 times per procedure in the bolus group and 0.38 ± 0.77 times in the continuous group (P = 0.977). One patient in the bolus group developed cerebral hemorrhage.

Conclusion

Continuous administration allows the maintenance of a necessary level of anticoagulation with lower doses of enoxaparine during CVVH as compared with bolus dosing. It still needs to be clarified whether this difference in the mean dose of the anticoagulant may be important in reducing the complications.