Heparin locks with low and high concentration in haemodialysis patients: A systematic review and meta‐analysis

Abstract

AimThere is no evidence‐based consensus on the optimal concentration for heparin locks; several randomized controlled trials (RCTs) have evaluated the concentration of heparin locks, yet the results remain inconsistent. We aimed to assess heparin locks with low and high concentration in haemodialysis patients.MethodsWe performed a systematic review and meta‐analysis of RCTs focusing on the concentration in heparin locks. Studies were identified by searching PUBMED, EMBASE, Science Direct, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure (CNKI) and Wanfang databases (from inception to 15 March 2020). Summary risk ratios or mean differences with 95% confidence interval were calculated.ResultsA total of 370 patients with four RCTs were included. Heparin locks with 1000 U/ml could significantly reduce the activated partial thromboplastin time (APTT) compared with 5000 U/ml. No significant differences were seen in the occurrence of catheter‐related thrombosis, the length of catheter stay, the rates of bleeding and catheter occlusions between the two groups.ConclusionsLower concentrations in heparin lock are optimal for shortening APTT in haemodialysis patients; further studies are needed to elucidate the role of heparin concentration in the lock practice.

Comparison of Catheter Related Blood Stream Infections in Hemodialysis Patients Treated With Trisodium Citrate as Catheter Locking Solution vs Heparin as Conventional Locking Method

“…7 Complications of heparin include inadvertent systemic anticoagulation, disturbances and laboratory evaluation of platelet aggregation, heparin-mediated thrombocytopenia, and an increased risk of bleeding, especially in uremic patients at risk of coagulopathy. 8 In vitro, sodium citrate has the potential to inhibit biofilm formation by certain bacteria, including Staphylococcus aureus and Staphylococcus epidermidis, especially on materials used for dialysis catheters. 9 High concentration of trisodium citrate (TSC) have been supported for hemodialysis catheter locking due to its local anticoagulant properties and potential antimicrobial effects.…”