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Malfunctioning temporary hemodialysis catheters in patients with novel coronavirus disease 2019.
Kanitra, John J; Power, Alexandra D; Hayward, R David; Haouilou, Jimmy C; Edhayan, Elango.
  • Kanitra JJ; Department of Surgery, Ascension St. John Hospital, Detroit, Mich.
  • Power AD; Department of Surgery, Ascension St. John Hospital, Detroit, Mich.
  • Hayward RD; Department of Surgery, Ascension St. John Hospital, Detroit, Mich. Electronic address: richard.hayward@ascension.org.
  • Haouilou JC; Department of Surgery, Ascension St. John Hospital, Detroit, Mich.
  • Edhayan E; Department of Surgery, Ascension St. John Hospital, Detroit, Mich.
J Vasc Surg ; 73(6): 1881-1888.e3, 2021 06.
Article in English | MEDLINE | ID: covidwho-1096146
ABSTRACT

OBJECTIVE:

The hypercoagulability seen in patients with novel coronavirus disease 2019 (COVID-19) likely contributes to the high temporary hemodialysis catheter (THDC) malfunction rate. We aim to evaluate prophylactic measures and their association with THDC patency.

METHODS:

A retrospective chart review of our institutions COVID-19 positive patients who required placement of a THDC between February 1 to April 30, 2020, was performed. The association between heparin locking, increased dosing of venous thromboembolism (VTE) prophylaxis and systemic anticoagulation on THDC patency was assessed. Proportional hazards modeling was used to perform a survival analysis to estimate the likelihood and timing of THDC malfunction with the three different prophylactic measures. We also determined the mortality, rate of THDC malfunction and its association with d-dimer levels.

RESULTS:

A total of 48 patients with a mortality rate of 71% were identified. THDC malfunction occurred in 31.3% of patients. Thirty-seven patients (77.1%) received heparin locking, 22 (45.8%) received systemic anticoagulation, and 38 (79.1%) received VTE prophylaxis. Overall, the rate of THDC malfunction was lower at a trend level of significance, with heparin vs saline locking (24.3% vs 54.6%; P = .058). The likelihood of THDC malfunction in the heparin locked group is lower than all other groups (hazard ratio [HR], 0.07; 95% confidence interval [CI], 0.01-0.45]; P = .005). The rate of malfunction in patients with subcutaneous heparin (SQH) 7500 U three times daily is significantly lower than of the rate for patients receiving none (HR, 0.03; 95% CI, 0.001-0.74; P = .032). A trend level significant association was found for SQH 5000 U vs none (P = .417) and SQH 7500 vs 5000 U (P = .059). Systemic anticoagulation did not affect the THDC malfunction rate (P = .240). Higher d-dimer levels were related to greater mortality (HR, 3.28; 95% CI, 1.16-9.28; P = .025), but were not significantly associated with THDC malfunction (HR, 1.79; 95% CI, 0.42, 7.71; P = .434).

CONCLUSIONS:

Locking THDCs with heparin is associated with a lower malfunction rate. Prospective randomized studies will be needed to confirm these findings to recommend locking THDC with heparin in patients with COVID-19. Increased VTE prophylaxis suggested a possible association with improved THDC patency, although the comparison lacked sufficient statistical power.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Heparin / Renal Dialysis / Equipment Failure / Venous Thromboembolism / Central Venous Catheters / COVID-19 / Anticoagulants Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Topics: Long Covid Limits: Aged / Female / Humans / Male Language: English Journal: J Vasc Surg Journal subject: Vascular Diseases Year: 2021 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Heparin / Renal Dialysis / Equipment Failure / Venous Thromboembolism / Central Venous Catheters / COVID-19 / Anticoagulants Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Topics: Long Covid Limits: Aged / Female / Humans / Male Language: English Journal: J Vasc Surg Journal subject: Vascular Diseases Year: 2021 Document Type: Article