Abstract: PO0820
Pre-Filter Argatroban for Coronavirus Disease 2019
Session Information
- COVID-19: Clinical Characteristics and Cases
October 22, 2020 | Location: On-Demand
Abstract Time: 10:00 AM - 12:00 PM
Category: Trainee Case Report
- 000 Coronavirus (COVID-19)
Authors
- Villanueva-Meyer, Pablo, Baylor College of Medicine, Houston, Texas, United States
- Thomas, Sandhya S., Baylor College of Medicine, Houston, Texas, United States
Introduction
Coronavirus disease – 2019 (Covid-19) has been implicated in a pro-thrombotic state. This has been well documented in numerous articles and has posed to be a difficult obstacle for those caring for Covid-19 positive patients. This has been particularly challenging for Nephrologist managing patients on continuous renal replacement therapies (CRRT). Amongst other things, filter clotting has been associated with an increased number of transfusions and interruptions in sustained therapy, as well as increased costs to the healthcare systems and patients.
Case Description
We present the case of a 73-year old African American male with a past medical history of underlying chronic kidney disease, hypertension, diabetes mellitus, heart failure, and atrial fibrillation who was admitted from his nursing facility after being found to be altered. Upon presentation to the hospital, the patient was screened for SARS-CoV-2 and found to be positive. He was transferred to the intensive care unit due to septic shock requiring vasopressors. Given oliguria, worsening acidosis, and metabolic derangements the patient was started on CRRT. Hospitalization was complicated by acute lower limb ischemic. Direct thrombolysis was unable to be performed due to thrombocytopenia and the patient subsequently underwent a guillotine amputation of the right lower extremity. CRRT was continued however multiple issues with filter clotting were noted despite systemic anticoagulation with heparin. The patient was transitioned to Argatroban as thrombocytopenia worsened and there was a concern for heparin-induced thrombocytopenia. Following the transition to Argatroban, the patient’s filter life was exponentially increased and only replaced per hospital protocol. No further issues with clotting were reported with the dialysis circuit.
Discussion
The pathogenesis of hypercoagulability associated with Covid-19 is not fully understood. Techniques utilized to minimize the risk of clotting include increasing the blood flow rate, regional and systemic anticoagulation, and running replacement fluids pre-filter. The role of Argatroban, a direct thrombin inhibitor, in treating Covid-19 patients has not been well documented. We report the case of a patient who was successfully anti-coagulated with Argatroban being run pre-filter. Pertinent outcomes included prolonging filter life, elimination of filter clotting events, and fewer interruptions in CRRT.