We conducted a prospective observational study to assess the efficacy of
continuous venovenous hemofiltration (CVVH) with no anticoagulation. A standard anticoagulation protocol for CVVH, which prescribed no anticoagulation for patients at risk of
bleeding, was applied to 48
critically ill patients treated with CVVH. Circuit life was prospectively observed, and the following data were obtained for each circuit:
heparin use and dose,
protamine use, daily prothrombin time-international normalized ratio, activated partial thromboplastin time, and platelet count. Out of 300 consecutive circuits, 143 (47.6%) received no anticoagulation, 31 (10.3%) received regional anticoagulation, and 126 received low dose
heparin. No patients experienced
bleeding complications secondary to CVVH. Platelet count was significantly lower in the no anticoagulation group (73 x 10(3)/microl) compared with the low dose
heparin group (119 x 10(3)/microl) and the
protamine group (104 x 10(3)/microl) (p < 0.01 for both comparisons). There was no significant difference in mean circuit life among the three groups (
heparin, 20.9 hours; no anticoagulation, 19.3 hours;
protamine, 21.2 hours; not significant). In conclusion, for a group of patients deemed to be at risk of
bleeding, CVVH without anticoagulation achieved an acceptable circuit life, which was similar to that obtained in other patients with low dose
heparin anticoagulation or regional anticoagulation with
heparin/
protamine.