New CRRT anticoagulation publication

In summary this pilot study shows an improvement in platelet count by using tirofiban (Aggrastat) and unfractionated heparin over just heparin to anti-coagulate CRRT patients.

Tirofiban preserves platelet loss during continuous renal replacement therapy in a randomised prospective open-blinded pilot-study

Andreas Link, Matthias Girndt, Simina Selejan, Ranja Rbah and Michael Bohm

Critical Care 2008, 12:R111

Abstract (provisional)

Introduction

Approximately one third of all patients with cardiogenic shock suffer from acute kidney injury. Percutaneous coronary intervention (PCI), intra-aortic balloon counterpulsation (IABP) and continuous renal replacement therapy (CRRT) require effective antiplatelet therapy and anticoagulation resulting in a high risk for platelet loss and bleeding events. The reversible platelet glycoprotein (GP) IIb/IIIa receptor inhibitor tirofiban was investigated to preserve platelet number and activation in a prospective open-blinded endpoint evaluation study.

Conclusions

This pilot study provides evidence that the use of tirofiban in addition to UFH prevents platelet loss and preserves platelet function in patients with cardiogenic shock and acute kidney injury requiring CRRT. The pathophysiological inhibition of platelet aggregation and platelet-monocyte interaction appears to be causally involved.

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