Abstract: SA-PO445
Incidence Rates of Bleeding Events With Heparin Administration in Chronic Hemodialysis Patients: A Systematic Review and Meta-Analysis
Session Information
- Hemodialysis and Frequent Dialysis: Clearance, Technology, Infection
November 05, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 701 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Raimann, Jochen G., Renal Research Institute, New York, New York, United States
- Gauly, Adelheid, Fresenius Medical Care Global Medical Office, Bad Homburg, Germany
- Willetts, Joanna, Fresenius Medical Care Global Medical Office, Waltham, Massachusetts, United States
- Lama, Suman Kumar, Fresenius Medical Care Global Medical Office, Waltham, Massachusetts, United States
- Blankenship, Derek M., Fresenius Medical Care Global Medical Office, Waltham, Massachusetts, United States
- Deluca, Thomas Pasquale, Fresenius Medical Care Global Medical Office, Waltham, Massachusetts, United States
- Chavez, Jonathan, Hospital Civil de Guadalajara Unidad Hospitalaria Fray Antonio Alcalde, Guadalajara, Jalisco, Mexico
- Delgado Figueroa, Netzahualpilli, Hospital Civil de Guadalajara Unidad Hospitalaria Fray Antonio Alcalde, Guadalajara, Jalisco, Mexico
- Garcia-Garcia, Guillermo, Hospital Civil de Guadalajara Unidad Hospitalaria Fray Antonio Alcalde, Guadalajara, Jalisco, Mexico
Background
To ensure patency of the extracorporeal circuit and vascular access, anticoagulation by systemic heparinization is usually performed during hemodialysis (HD). Heparin may have adverse effects such as bleeding, heparin-induced thrombocytopenia, and others, which may be a burden to the HD patients, to health care providers and to health care systems. The aim of this systematic literature review and meta-analysis was to provide a comprehensive overview of the incidence of bleeding events in heparinized HD patients and to estimate the variation associated with different types of heparins.
Methods
We searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) database for English-language articles from January 1, 2000, to DATE. We included prospective, randomized, controlled trials and observational studies that include chronic HD patients in whom unfractionated heparin (UFH) or low-molecular-weight heparin (LMWH), was used for systemic anticoagulation, and in which adverse effects of heparin as primary or secondary end points were reported. A random intercept Poisson regression model with maximum likelihood estimation was applied to estimate incidence rates. All articles were screened by two reviewers; discrepant assessments were cross-checked by a third reviewer. The detailed methodology has been published as PROSPERO Registration no. 239695.
Results
Screening of 3764 articles resulted in 20 articles with data that could be used for our meta-analysis. The incidence rate of minor and major bleeding events per 100 patient years for LMWH was 13.8 (95% CI 4.0 to47.3) and for UFH was 6.2 (95% CI 2.5 to 15.5). Regional variability and a period effect associated with changes in practice patterns is being subject of additional research.
Conclusion
Our research quantified the incidence rates of bleeding associated with heparin administration in HD patients. Differences between the types of heparins need to be appreciated and should be subject of further research. A clear difference of heparin estimates to populations with no heparin administration, emphasizes the need for improvements allowing for minimization of the need for heparin administration.