Scientific Poster Session II - Original Research

Original Research
  Sunday, November 12, 2023
  12:45 PM–02:15 PM

Abstract

Introduction: Continuous renal replacement therapy (CRRT) is commonly used in critically ill patients. Clotting of the circuit is a known complication. Minimal data exist for the use of systemic epoprostenol to maintain circuit patency.

Research Question or Hypothesis: Is epoprostenol an effective and safe therapy for maintaining CRRT filter patency?

Study Design: This was a retrospective study of patients who received intravenous epoprostenol for CRRT filter patency between December 2018 and December 2022 at IU Health Methodist and University Hospitals.

Methods: The primary outcome is CRRT filter life up to 96 hours pre- and post-epoprostenol initiation. Secondary outcomes include the incidence of bleeding and hypotension. Patients who were on CRRT and received IV epoprostenol for circuit patency were included. Patients were excluded from the primary outcome if they received less than 12 hours of treatment.

Results: 21 patients were included overall, and 18 patients were included in the analysis for the primary outcome. The median filter life in the pre-epoprostenol group was 19.2 hours (IQR 11.2 - 20.3) compared to 19.7 (IQR 12.3 - 32) hours in the post-epoprostenol group (p = 0.223). There was an increase in vasopressors within 2 hours after initiating epoprostenol (norepinephrine-equivalents 0.10 mcg/kg/min vs 0.16 mcg/kg/min; p=0.003). Four patients had a minor bleed requiring a blood transfusion of < 4 units, and no patients had a major bleed requiring a blood transfusion of = 4units.

Conclusion: There was no difference in CRRT filter life after the initiation of systemic epoprostenol. There was an increase in vasopressors after epoprostenol was initiated, but there were low rates of minor bleeding and no major bleeding events. These results support the use of epoprostenol in patients who are unable to receive standard anticoagulation during CRRT. Additional studies comparing epoprostenol to other agents would be warranted to further assess the efficacy and safety of epoprostenol for CRRT circuit patency.

Presenting Author

Mollie Myers PharmD
Indiana University Health

Authors

Rachel Kruer PharmD
The Johns Hopkins Hospital

Quinn Czosnowski PharmD, BCPS
IU Health Methodist Hospital

Arianna Vidger PharmD, BCCCP
Indiana University Health