O-201 Prostacyclin (epoprostenol) As An Anticoagulant In Continuous Renal Replacement Therapy (crrt) In Paediatric Acute Liver Failure (palf)

Abstract

Background Patients with Acute Liver Failure (ALF) are pro-thrombotic and hence prone to circuit clotting leading to treatment downtimes on CRRT. In patients with ALF, heparin may either be contraindicated (thrombocytopenia) or insufficient (pro-coagulant). Epoprostenol, and an anti-platelet agent could be an alternative to heparin to prevent circuit clotting. Aims To investigate efficacy and safety of Epoprostenol (synthetic prostacyclin analogue) as sole anti-haemostatic agent used for circuit patency during CRRT in patients with ALF. Methods Prospective study of children with ALF admitted to PICU receiving CRRT over a 7 year period. Patients were stratified according to the used anticoagulant Epoprostenol PGI(2) group (n = 65) and non-epoprostenol group (n = 43). Efficacy was measured by filter life and mortality. Safety was assessed by number of bleeding episodes during CVVH, platelet consumption and hypotensive episodes (requirement for fluids/vasopressors). Results 108 ALF patients underwent CRRT for a total of 17715 h utilising 587 filters (5,4 circuits/patient). Epoprostenol was used in 65 patients at the dose of 4 ng/kg/min administered pre-filter for a total of 8366 h. In the non-epoprostenol group 43 patients underwent CRRT for 8044 h using unfractionated heparin. Median filter life was 32,7 h in Epoprostenol group and 24.9 h in non-epoprostenol group (p Conclusions Epoprostenol as the sole anti-haemostatic agent for CRRT increases mean filter life, decreases bleeding risk without increasing risk of hypotension, platelet transfusion or mortality.