Kidney Week

Abstract: FR-PO757

Safety and Efficacy of Heparin During Dialysis in the Context of Systemic Anticoagulant and Antiplatelet Medications

Session Information

• Dialysis: Inflammation and Infection
  October 26, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• Brunelli, Steven M., DaVita Clinical Research, Minneapolis, Minnesota, United States

Steven M. Brunelli,

• Cohen, Dena E., DaVita Clinical Research, Minneapolis, Minnesota, United States

Dena E. Cohen,

• Marlowe, Gilbert, DaVita Clinical Research, Minneapolis, Minnesota, United States

Gilbert Marlowe,

• Liu, Daniel, DaVita Institute for Patient Safety, Denver, Colorado, United States

Daniel Liu,

• Njord, Levi, DaVita Institute for Patient Safety, Denver, Colorado, United States

Levi Njord,

• Van Wyck, David B., DaVita Institute for Patient Safety, Denver, Colorado, United States

David B. Van Wyck,

• Aronoff, George R., DaVita Kidney Care, Denver, Colorado, United States

George R. Aronoff,

Background

Heparin is widely used to prevent coagulation during hemodialysis (HD). Although systemic anticoagulants and antiplatelet agents are commonly prescribed in the HD population, the safety and efficacy of heparin in the presence versus absence of these medications is unclear.

Methods

This retrospective, longitudinal, time-updated cohort study considered adult patients receiving in-center HD (Aug 2015 – Jul 2017). Study data were derived from deidentified patient electronic health records. For each calendar month, patients were ascribed a 3-part exposure status (use of heparin, systemic anticoagulant, systemic antiplatelet agent). Outcomes included anemia measures, peri-treatment bleeding and clotting, and hospitalization for gastrointestinal (GI) bleeding. Within each systemic medication exposure category, associations of heparin use (vs. non-use) were examined using adjusted general linear, negative binomial, or Poisson models.

Results

Across all systemic medication exposures, heparin use (vs. non-use) was associated with significantly lower erythropoiesis stimulating agent (ESA) dose and higher hemoglobin values; slightly lower intravenous (IV) iron dose; and similar serum ferritin and transferrin saturation. Heparin use was also associated with lower rates of clotting during treatment. Heparin use was not associated with excess risk of hospitalization for GI bleeding, or with peri-treatment bleeding episodes. Associations with respect to ESA, IV iron, hemoglobin, and clotting were approximately 2-fold more potent in the absence of a systemic anticoagulant; the presence of a systemic antiplatelet agent did not impact these associations. Neither systemic medication type influenced associations between heparin use and peri-treatment or GI bleeding.

Conclusion

Heparin use was safe and effective regardless of systemic anticoagulant and antiplatelet agent status. Clinical judgment must be applied to assess bleeding risk in individual patients; however, the decision to withhold heparin should not solely be based upon the concurrent use of systemic anticoagulant or antiplatelet agents.

Funding

• Commercial Support –