title: Concentrated heparin lock is associated with major bleeding complications after tunneled hemodialysis catheter placement.
abstract: Vascular access complications, including thrombosis, are associated with significant patient morbidity and mortality. Currently, up to 60% of new patients and 30% of prevalent patients are using a catheter for dialysis. To prevent interdialytic catheter thrombosis, these devices are routinely locked with concentrated heparin solutions. Several recent studies have elucidated the potential for abnormal coagulation markers (aPTT) that may arise from this practice. This abnormal elevation in aPTT may be explained by significant early and late leakage from the catheter that occurs after performing a catheter lock. To date no study has evaluated the impact of this practice, or the elevation in aPTT that may result from it, on bleeding complication rates. We conducted a retrospective analysis comparing bleeding rates in subjects who received concentrated heparin catheter lock (5000 u/cc) [group 1, n = 52] to those who received citrate or dilute heparin catheter lock (1000 u/cc) [group 2, n = 91] immediately after tunneled hemodialysis catheter insertion. Baseline characteristics did not differ between the groups except for the preprocedure INR, which was higher in the postpolicy group compared with the prepolicy group (1.29 vs. 1.21, p = 0.04). Results from logistic regression analyses revealed that the likelihood of a composite bleeding event in group 1 was 11.9 times that of a composite bleeding event in group 2, p = 0.04. Concentrated heparin (5000 u/ml) is associated with increased major bleeding complications posttunneled catheter placement compared with low-dose heparin (1000 u/ml) or citrate catheter lock solution, p = 0.02. Given the findings of this study, a randomized controlled trial comparing the safety and efficacy of common anticoagulation lock solutions is warranted.
authors.affiliation: University of Wisconsin Hospital, Madison, Wisconsin 53713, USA.
authors.forename: Alexander S
authors.initials: AS
authors.lastname: Yevzlin
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Sanchez
authors.forename: Jeanne G
authors.initials: JG
authors.lastname: Hiatt
authors.forename: Marilyn H
authors.initials: MH
authors.lastname: Washington
authors.forename: Maureen
authors.initials: M
authors.lastname: Wakeen
authors.forename: R Michael
authors.initials: RM
authors.lastname: Hofmann
authors.forename: Yolanda T
authors.initials: YT
authors.lastname: Becker
mesh_terms: D002405:Catheterization, Central Venous / Q000009:adverse effects*; D016009:Chi-Square Distribution; D005260:Female; D006083:Graft Occlusion, Vascular / Q000209:etiology / Q000517:prevention & control; D006470:Hemorrhage / Q000209:etiology*; D006493:Heparin / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012189:Retrospective Studies; D013927:Thrombosis / Q000209:etiology / Q000517:prevention & control
chemical_list: D006493:Heparin