Use and safety of heparin-free maintenance hemodialysis in the USA

Abstract

Patient markers of increased risk of bleeding and facility region associated with heparin-free HD use. Despite the potential benefits of avoiding heparin use, heparin-free HD was not significantly associated with decreased hazards of death, bleeding or thrombosis, suggesting that it may be no safer than HD with heparin.

A bioinspired omniphobic surface coating on medical devices prevents thrombosis and biofouling

“…Countless lives have been saved by implantable medical devices (e.g., total artificial hearts, ventricular assist devices, pacemakers, cardioverterdefibrillators, and central lines) and extracorporeal devices that flow whole human blood outside the body through indwelling catheters and external circuits, during cardiopulmonary bypass (CPB), hemodialysis, and extracorporeal membrane oxygenation (ECMO) 1,2 . However, the need to co-administer soluble anticoagulant drugs, such as heparin, with many of these procedures, significantly reduces their safety and hampers their effectiveness 3,4 .…”

“…Although this approach has been widely adopted, major limitations persist because the surface-bound heparin leaches, resulting in a progressive loss of anticoagulation activity 4,11 and the use of heparin-coated materials has not led to a drastic reduction in the clinical use of soluble heparin 12 . Some high-flow dialysis treatments can be carried out without heparin in subsets of patients with high bleeding risks, but even in this patient population, half are forced to switch to heparin bolus dialysis within the first year of treatment 2 . Due to these limitations, other non-thrombogenic, hydrophilic material coatings have been explored, including PHISIO (Sorin) 13 , Trillium (Medtronic) 14 , PMEA polymer 15 , and sulfobetaine 16 .…”

Heparin-free haemodialysis—use and outcomes

“…3,4,6 Although the avoidance of heparin anticoagulation during haemo dialysis is generally thought to have beneficial effects, such as a reduction in bleeding risk, new data from a study by Shen et al suggest that this assumption might not be correct. 7 To identify the clinical factors and outcomes associated with use of heparin-free haemodialysis versus standard haemo dialysis with heparin, Shen et al conducted a retrospective analysis of data from the United States Renal Data System and electronic medical records. 7 They report that in their cohort of 12,468 patients aged 67 years or older who initiated maintenance haemodialysis between January 2007 and December 2008, only 836 patients (6.7%) were dialysed without heparin.…”

“…7 To identify the clinical factors and outcomes associated with use of heparin-free haemodialysis versus standard haemo dialysis with heparin, Shen et al conducted a retrospective analysis of data from the United States Renal Data System and electronic medical records. 7 They report that in their cohort of 12,468 patients aged 67 years or older who initiated maintenance haemodialysis between January 2007 and December 2008, only 836 patients (6.7%) were dialysed without heparin. 7 Unsurprisingly, higher odds of heparin-free haemodialysis were associated with conditions that indicate an increased risk of bleeding, such as a history of gastrointestinal bleeding and/or haemorrhagic stroke, low haemoglobin levels and low platelet counts.…”

“…7 They report that in their cohort of 12,468 patients aged 67 years or older who initiated maintenance haemodialysis between January 2007 and December 2008, only 836 patients (6.7%) were dialysed without heparin. 7 Unsurprisingly, higher odds of heparin-free haemodialysis were associated with conditions that indicate an increased risk of bleeding, such as a history of gastrointestinal bleeding and/or haemorrhagic stroke, low haemoglobin levels and low platelet counts. A history of deep vein thrombosis was also independently associated with use of heparin-free haemo dialysis.…”