1.
Safety and efficacy of heparin during dialysis in the context of systemic anticoagulant and antiplatelet medications.
Brunelli, SM, Cohen, DE, Marlowe, G, Liu, D, Njord, L, Van Wyck, D, Aronoff, G
Journal of nephrology. 2019;(3):453-460
Abstract
Heparin is widely used to prevent coagulation during hemodialysis. Although systemic anticoagulants and antiplatelet agents are commonly prescribed in the hemodialysis population, the safety and efficacy of heparin in the presence of these medications is unclear. This retrospective cohort study considered adult hemodialysis patients treated in the United States (August 2015-July 2017). For each month, patients were ascribed a three-part exposure status (heparin use, anticoagulant use, antiplatelet agent use) based on electronic health records. Outcomes included anemia measures, peri-treatment bleeding and clotting, and hospitalization for gastrointestinal (GI) bleeding. Within systemic medication exposure categories, associations of heparin use were examined using adjusted generalized linear, negative binomial, or Poisson models. Across all systemic medication exposures, heparin use was associated with lower erythropoiesis stimulating agent (ESA) dose, higher hemoglobin levels, and lower monthly intravenous (IV) iron dose; lower rates of clotting during treatment and hospitalization for GI bleeding; and similar rates of peri-treatment bleeding. Associations with respect to ESA, IV iron, hemoglobin, and clotting were approximately twofold more potent in the absence of a systemic anticoagulant; the presence of an antiplatelet agent had little impact. Neither medication type influenced associations between heparin use and peri-treatment or GI bleeding. These results suggest that heparin use is safe and effective in the presence and absence of systemic anticoagulants and antiplatelet agents. 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 anticoagulant or antiplatet agents.
2.
[Local drugs in treating and decreasing the incidence of adverse reactions after sclerotherapy of telangiectasia].
Bogachev, VI, Boldin, BV, Turkin, PI, Lobanov, VN
Angiologiia i sosudistaia khirurgiia = Angiology and vascular surgery. 2019;(4):102-107
Abstract
AIM: The purpose of the study was to assess efficacy and safety of heparin sodium gel 1000 IU/g and Detragel® in decreasing the incidence and treatment of the most common local adverse reactions in patients after endured sclerotherapy of reticular veins and telangiectasias. PATIENTS AND METHODS Our open prospective observational study included a total of sixty 18-to-35-year-old female patients who after undergoing standardized sclerotherapy of reticular veins and telangiectasias on symmetrical portions of lower limbs were given a tube of heparin sodium gel 1000 IU/g or Detragel® to be applied onto the skin of one (left) lower limb in the projection of the sclerotherapy-exposed vessels 2-3 times daily for 10 days followed by putting on a compression class 2 (RAL standard) stocking. The women were allowed to use only the paired stocking on the contralateral extremity. Efficacy and safety of heparin sodium gel 1000 IU/g and Detragel® were evaluated based on the incidence of typical adverse reactions (ecchymoses, phlebitides, hyperpigmentation and neovasculogenesis), as well as on the patient's subjective perceptions. RESULTS The use of heparin sodium gel 1000 IU/g and Detragel® in addition to compression after sclerotherapy of reticular veins and telangiectasias significantly and comparably decreased the incidence and accelerated the resolution of ecchymoses and phlebitides associated with phlebosclerosing treatment. The Detragel® group patients were found to develop hyperpigmentation or neovasculogenesis significantly less often as compared with the heparin sodium gel 1000 IU/g group women. What is more, using Detragel® was not accompanied by hyperkeratosis, pruritus or formation of a sticky film, the events, however, observed while applying heparin sodium gel 1000 IU/g. CONCLUSION The use of Detragel® or heparin sodium gel 1000 IU/g for 10 days additionally to compression significantly decreased the incidence of typical undesirable reactions associated with sclerotherapy of reticular veins and telangiectasias. The Detragel® group women turned out to have lower incidence of hyperpigmentation and neovasculogenesis. Besides, Detragel® demonstrated better organoleptic properties.
3.
Citrate versus heparin for apheresis catheter locks: an efficacy analysis.
Passero, BA, Zappone, P, Lee, HE, Novak, C, Maceira, EL, Naber, M
Journal of clinical apheresis. 2015;(1):22-7
Abstract
INTRODUCTION There is a paucity of medical literature regarding the efficacy of lock solutions in preventing catheter thrombosis. Traditionally, heparin has been used as the anticoagulant of choice for catheter locking, but it has many adverse effects associated with its use. Sodium citrate 4% is an attractive alternative to heparin. METHODS Our plasmapheresis unit converted to locking all central venous catheters with sodium citrate 4% in place of heparin 100 units/mL in May 2010. We conducted a 2-year period retrospective observational cohort study comparing the outcomes of using heparin versus citrate locks. Outcomes examined were catheter patency, catheter exchanges, alteplase usage, and catheter infections. RESULTS During the study period, 84 patients who underwent a total of 554 plasmapheresis treatments were identified. Flow problems among the citrate treatments were more frequent than those among the heparin group (6.5% vs. 3.2%, P = 0.11, n = 554) but this did not reach statistical significance. The frequency of more severe flow problems requiring catheter exchange or alteplase infusion was higher among the citrate group than the heparin group (3.2% vs. 1.3%, P = 0.11, n = 554). Subgroup analysis, stratified by diagnosis, demonstrated that there was a statistically significant difference in flow problems when comparing myasthenia gravis (MG) patients to non-MG patients. There was no difference in catheter infections between the groups. CONCLUSIONS Based on the findings of our study, we conclude that citrate and heparin locks have similar efficacy in maintaining catheter patency in plasmapheresis patients. Further research is needed to examine the differences observed between MG patients versus all other patients.