(696) Efficacy and Safety: A Comparison of Prostacyclin to Heparin and Citrate in Children Receiving CRRT

Introduction: Anticoagulants are used in continuous renal replacement therapy (CRRT) to prolong filter life. When compared to citrate and heparin, prostacyclin, a platelet inhibitor, has the advantage of requiring less lab monitoring. The primary aim of this study was to assess the efficacy and safety of prostacyclin as compared to heparin and citrate anticoagulation in CRRT.

Methods: We performed a retrospective analysis of patients aged 0-26 years admitted to an academic quaternary care children’s hospital from 2017-2022 who received heparin, prostacyclin or citrate for CRRT anticoagulation. Kruskal-Wallis and Pearson’s Chi square tests were used to compare continuous and categorical variables, respectively.

Results: Of the 101 patients included, 44 received prostacyclin (43.5%), 38 received heparin (37.6%), and 19 received citrate (18.8%). There were 12,816 hours on prostacyclin, 11,102 hours on heparin and 3,391 hours on citrate included in the analysis. Patient groups were similar regarding baseline characteristics, including severity of illness. The first filter change was more commonly planned in patients receiving anticoagulation with prostacyclin (43%) as compared to heparin (29%) or citrate (11%) (P=.03). For patients whose first filter change was not planned, there was a greater median time (hours) until the filter was replaced in the prostacyclin group (29; IQR 27-48) when compared to those receiving heparin (18; IQR 15-27) or citrate (21; IQR 12-25) (P=.001). There was a smaller median ratio of filters used to days on therapy in patients receiving prostacyclin (0.53; IQR 0.41-0.85) as compared to heparin (1; IQR 0.5-1.13) or citrate (0.75; IQR 0.5-1.08) (P=.01). There was no significant decline in platelet count or change in PTT/INR when comparing values prior to CRRT initiation and through 10 days of therapy for those receiving prostacyclin. There was no difference in vasoactive-ionotropic score when comparing patients prior to CRRT initiation through the first 3 hours of therapy for patients receiving each of the 3 types of anticoagulation.

Conclusions: Prostacyclin is an effective anticoagulant in CRRT with a similar side effect profile and improved circuit life compared to heparin and citrate. Larger, multicenter studies would be beneficial given the limitations of our single center study.