Déficit acquis en Antithrombine et hemofiltration

Abstract

Objective. — Continuous renal replacement therapy (CRRT) is widely used in the management of septic patient with acute renal failure (ARF). Short filter lifespan (<24h) is a major concern and could result of a procoagulating state. The aim of this work is to study the relationship between antithrombin (AT) deficit and early filter clotting, and whether supplementation of AT could increase filter lifespan. We also compare two different methods for supplementation : Bolus Vs Continuous Infusion. Design and Setting. — The authors conducted a two center prospective study from March 2003 till May 2004. Patients: Twenty-seven patients in septic shock and ARF were included and treated by CRRT. Unfractionned heparin (UHF) was used for anticoagulation. Supplementation was started after two early filters's clotting with the two different methods. Measurements and main results: The level of AT was measured before CRRT and every day. The risk of thromboses increases dramatically at a threshold rate of 60 %. Supplementation allows a longer filter lifespan (15,2 h to 33,2h). Continuous infusion allows better Results. — 48,5 h vs. 27,8 h for bolus method. The loglinear regression with frailty is statistically significant shows a high correlation between filter lifespan logarithm and AT level ( P<0,00I ) Conclusion. — This study shows that a level of AT under 60 % increases the risk of early filter clotting. A supplementation of AT could increase the filter lifespan by more than 100 %. Continuous infusion should be preferred. Cost effectiveness should be evaluated shortly.