Position Statement on Heparin Safety Concerns

Riley, Margaret A.; Meyers, Rachel

doi:10.5863/1551-6776-21.6.530

Cited by 4 publications

(2 citation statements)

References 4 publications

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“…Additional safety concerns relate to heparin dosing. UFH is supplied in multiple concentrations (1 units/mL to 20 000 units/mL) and errors in administration, particularly in paediatric practice, have led to patient harm and even death 13 . This potential risk may be further increased when practitioners lack familiarity with the product, as may be the case when apheresis centres use ACD‐A for all procedures except ECP.…”

Section: Discussionmentioning

confidence: 99%

UK national survey of anticoagulation in extra‐corporeal photopheresis—Is it time for a UK consensus statement?

Wolf

Alfred

Gennery

et al. 2021

Transfusion Medicine

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Background Extra‐corporeal photopheresis (ECP) requires anticoagulation to prevent circuit clotting. Unfractionated heparin (UFH) is currently the only anticoagulant licensed for the ECP system in use in the United Kingdom (UK). Acid citrate dextrose‐A (ACD‐A) is the preferred anticoagulant for most other apheresis procedures. Anecdotal evidence suggested variability in ECP practice across the UK with some providers using off‐label ACD‐A. Aims We developed a survey together with the UK Photopheresis Society to establish current practice. Materials & Methods This was distributed to all 17 ECP providers covering 34 UK sites. Results Significant variability in practice was demonstrated with only 36% of responding providers (5/14) using UFH exclusively and 29% (4/14) using ACD‐A as standard. Conclusion This survey highlights the need for a UK consensus.

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Section: Discussionmentioning

confidence: 99%

UK national survey of anticoagulation in extra‐corporeal photopheresis—Is it time for a UK consensus statement?

Wolf

Alfred

Gennery

et al. 2021

Transfusion Medicine

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“…However, it is recognized that heparin can be ordered and then diluted to perform the flush, thus potentially artificially inflating proportions of heparin exposure. To address this, we evaluated the captured dosing form of heparin and removed those below 100 units as discussed by Riley and colleagues 22 . Finally, all heparin without both a documented dosage unit and strength were also excluded. Multi‐allograft patients : Although we focus on the patients' initial transplant event, it was observed a proportion of patients ( n = 70) received a second liver transplant in the same encounter, with a mean and median time to second transplant of 15 and 8 days respectively.…”

Section: Methodsmentioning

confidence: 99%

Hepatic artery thrombosis and use of anticoagulants and antiplatelet agents in pediatric liver transplantation

Feldman,

Heble,

Hendrickson

et al. 2023

Pediatric Transplantation

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BackgroundHepatic artery thrombosis (HAT) is a reported complication of 5%–10% of pediatric liver transplantations, rates 3–4 times that seen in adults. Early HAT (seen within 14 days after transplant) can lead to severe allograft damage and possible urgent re‐transplantation. In this report, we present our analysis of HAT in pediatric liver transplant from a national clinical database and examine the association of HAT with anticoagulant or antiplatelet medication administered in the post‐operative period.MethodsData were obtained from the Pediatric Health Information System database maintained by the Children's Hospital Association. For each liver transplant recipient identified in a 10‐year period, diagnosis, demographic, and medication data were collected and analyzed.ResultsOur findings showed an average rate of HAT of 6.3% across 31 centers. Anticoagulant and antiplatelet medication strategies varied distinctly among and even within centers, likely due to the fact there are no consensus guidelines. Notably, in centers with similar medication usage, HAT rates continue to vary. At the patient level, use of aspirin within the first 72 h of transplantation was associated with a decreased risk of HAT, consistent with other reports in the literature.ConclusionWe suggest that concerted efforts to standardize anticoagulation approaches in pediatric liver transplant may be of benefit in the prevention of HAT. A prospective multi‐institutional study of regimen—possibly including aspirin—following transplantation could have significant value.

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Exploring Pakistani Physicians' Knowledge and Practices Regarding High Alert Medications: Findings and Implications

et al. 2022

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Introduction: While many low-middle income countries (LMICs), including Pakistan, try and ensure patient safety within available resources, there are considerable concerns with medication use. Unsafe and inappropriate medication use, especially high alert medications (HAMs), is one of the important factors compromising patient safety and quality of care. Besides economic loss, HAMs contribute to greater morbidity, hospitalization, and mortality. Physicians as key members of the provision of healthcare are expected to be well aware of the administration and regulations surrounding HAMs. However, the current status is unknown in Pakistan. Consequently, the objectives of this study were to evaluate the knowledge of Pakistani physicians about the administration, regulation, and practices related to HAMs. This builds on our recently published study with nurses.Methods: An online cross-sectional study design was used, and data were gathered from the physicians throughout Pakistan using previously used self-administered questionnaires during a period of 5 months (January 1 to May 30, 2021). All data were entered and analyzed using SPSS 22 for Windows.Results: Physicians (847) who provided consent were enrolled in the study. Most physicians (62.2%) were male, aged between 25 and 30 years (75.2%) and had 2- to 5-year work experience (50.9%). About 27% were working in the emergency departments. The median (IQR) knowledge score for HAMs administration and regulation was 5 (3) and 5 (2), respectively. About 46.4% of respondents were found to have moderate knowledge about HAMs; increasing age, work experience, and higher qualifications were significantly associated (p < 0.05) with better HAMs knowledge. Around 58% had good practices relating to HAMs during their routine work. Median practice scores increased significantly (p < 0.05) with age, work experience, and postgraduate qualification.Conclusion: Most Pakistani physicians possess moderate knowledge about HAMs administration and regulations. However, their practices relating to the HAMs administration and regulations are typically sub-optimal. Consequently, HAMs awareness needs to be improved by including course content in the current curriculum, provision of hospital-based continuous training programs about patient safety and care, and establishment of multi-disciplinary health care teams, including board-certified pharmacists and specialized nurses, for the effective execution of medication use process in Pakistani hospitals in the future.

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Position Statement on Heparin Safety Concerns

Cited by 4 publications

References 4 publications

UK national survey of anticoagulation in extra‐corporeal photopheresis—Is it time for a UK consensus statement?

UK national survey of anticoagulation in extra‐corporeal photopheresis—Is it time for a UK consensus statement?

Hepatic artery thrombosis and use of anticoagulants and antiplatelet agents in pediatric liver transplantation

Exploring Pakistani Physicians' Knowledge and Practices Regarding High Alert Medications: Findings and Implications

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