[richard13]

In the ICU I currently work in I have noticed that our septic patients on CVVH, constantly clot off the filters of the Prisma and are only on the machine for about three hours. After changing the filter, (100cc of patient blood loss within the set-up and filter) we start treatment again only to have the filter clot off. Just last week we started Xigris in a patient who also started CVVH and did not clot the filter off once while on the drug. Does anyone have any other experiences like this one or are aware of any studies correlating the two? Thanks

[AmiK25]

I have not noticed a particular correlation with not clotting the filter and using xigris (maybe I just haven't noticed it...it might be there) but I was just wondering if your facility is not using heparin with your CVVH on septic patients? If a patient has severe coag problems we will try to run them with no heparin or even run a protamine gtt on the other side of the filter to counteract the heparin but otherwise we always try to use heparin and just monitor PTT's every 6 hours. We haven't had much trouble with coagulation problems or filters clotting off after 3-4 hours.

[Diprivan/Vented]

Pts with sepsis have a coagulopathy problem. They start forming clots. (That's why your CVVH machine clots so easily). This is where Xigris comes into the picture. Xigris helps gives some of the anti-clotting factors back to the body. If Xigris isn't used, then clots form, and these clots lodge themselves in various organs, including the liver and kidneys.

[richard13]

Propofol, does that mean you use xigris with every
septic patient on CVVH? Or do you use some other means
excluding heparin to prevent clotting off the filter?