Skip to main content

Safety of drotrecogin alfa (activated) treatment in patients with severe sepsis on renal replacement therapy without additional anticoagulation

Introduction

Patients with sepsis-induced acute renal failure on continuous renal replacement therapy (CRRT), who receive heparin, may be at higher risk of bleeding when drotrecogin alfa activated (DAA) is administered in addition to standard anticoagulation, especially surgical patients. There are some previous observations that no additional anticoagulation is necessary during simultaneous DAA infusion and CRRT. The aim of this study was to evaluate the safety of CRRT during DAA infusion without additional anticoagulant therapy.

Methods

An observational, prospective study was conducted in an adult ICU. Sixteen surgical patients with severe sepsis on CRRT were divided into two groups: group A (eight patients) with DAA infusion, group B (eight patients) without DAA infusion. Baseline demographics, APACHE II score, serious bleeding events, and in-hospital mortality were reported. CRRT was performed using the Multifiltrate® system, heparin-free continuous venovenous hemodialysis mode in group A. After the completion of the DAA infusion, intravenous standard heparin was administered for the remaining time on hemofiltration. In group B concomitant heparin was administered as necessary to achieve an aPTT of approximately 60 seconds.

Results

The mean filter survival time (defined as the time until the circuit clotted) was 30 hours on DAA infusion versus 22 hours after DAA infusion in group A and 19.6 hours in group B. All survivors had recovery of dialysis-free renal function. The mean APACHE II score was 31.25 in group A and 22.12 in group B. Hospital mortality was 50% in group A (4/8) and 37.5% in group B (3/8); no mortality was attributed to bleeding. One case of severe thrombocytopenia was recorded with premature interruption of DAA infusion. The need for transfusion of blood and blood products infusion was compared (61% during DAA infusion vs. 52% after DAA infusion; 55% in group B); no serious bleeding event in both groups.

Conclusions

The use of DAA in patients with severe sepsis requiring RRT is safe and is not associated with an increased of major bleeding events. No additional anticoagulation is necessary during simultaneous DAA infusion and CRRT.

References

  1. 1.

    Camporota L, et al.: Crit Care. 2008, 12: R163. 10.1186/cc7163

    PubMed Central  Article  PubMed  Google Scholar 

  2. 2.

    de Pont AC, et al.: Crit Care. 2009, 13: 113. 10.1186/cc7684

    PubMed Central  Article  PubMed  Google Scholar 

  3. 3.

    Payen D, et al.: Surgery. 2007, 141: 548-561. 10.1016/j.surg.2007.02.004

    Article  PubMed  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to L Mirea.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and Permissions

About this article

Cite this article

Mirea, L., Vasiliu, I.L., Ungureanu, R. et al. Safety of drotrecogin alfa (activated) treatment in patients with severe sepsis on renal replacement therapy without additional anticoagulation. Crit Care 15, P124 (2011). https://doi.org/10.1186/cc9544

Download citation

Keywords

  • Heparin
  • Severe Sepsis
  • Bleeding Event
  • Continuous Renal Replacement Therapy
  • Severe Thrombocytopenia