title: Acid-citrate-dextrose Formula A versus heparin as primary catheter lock solutions for therapeutic apheresis.
abstract: BACKGROUND
  Unfractionated heparin (UFH) is a commonly used catheter lock solution, but may lead to various complications. Acid-citrate-dextrose Formula A (ACD-A), the standard anticoagulant used in therapeutic apheresis (TA), is an alternative. We compared the efficacy of these two anticoagulants as primary catheter lock solutions.
  
  
  METHODS
  The following outcomes were analyzed retrospectively for all TA procedures performed between July 2009 and March 2012: patent, partial occlusion, total occlusion, catheter-related blood stream infection, tissue plasminogen activator use, and premature catheter removal.
  
  
  RESULTS
  Our primary data set included 5964 total catheter days, 3020 procedures, and 427 TA courses. The UFH group comprised 3444 catheter days and 1880 procedures; the ACD-A group, 2520 catheter days and 1140 procedures. Overall catheter-related outcomes differed by not more than 5.3% for the primary analysis and when stratified by short-term (≤10 days) duration or short dwell times (<3 days). When stratified by long-term duration (>10 days) and long dwell times (>3 days), differences increased to not more than 10.4 and 22.4%, respectively.
  
  
  CONCLUSIONS
  For short-term courses and short dwell times, UFH and ACD-A appear equally effective; UFH appears superior to ACD-A in the setting of long-term courses and long dwell times. Major catheter-related complications were rare and occurred with similar frequency in both groups. For most indications, ACD-A appears to be a reasonable alternative to heparin; however, an adequately powered, randomized trial would be required to definitively address this issue.
authors.affiliation: Department of Pathology, Department of Emergency Medicine, Keck School of Medicine of USC, Los Angeles, California; HemaCare Corp., Van Nuys, California; Department of Pathology and Laboratory Medicine, University of California at Irvine, Irvine, California.
authors.forename: Melanie
authors.initials: M
authors.lastname: Osby
authors.forename: Pat
authors.initials: P
authors.lastname: Barton
authors.forename: Chun Nok
authors.initials: CN
authors.lastname: Lam
authors.forename: Minh-Ha
authors.initials: MH
authors.lastname: Tran
mesh_terms: D001781:Blood Component Removal / Q000379:methods*; D019343:Citric Acid / Q000627:therapeutic use*; D005947:Glucose / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006493:Heparin / Q000627:therapeutic use*; D006801:Humans; D012189:Retrospective Studies
chemical_list: C002113:acid citrate dextrose; D019343:Citric Acid; D006493:Heparin; D005947:Glucose