Abstract Number: PB/CO05
Meeting: ISTH 2020 Congress
Background: Critically ill patients with COVID-19 have high rates of thrombotic complications, including frequent line thrombosis. In response to this issue, a low dose heparinized saline (LDHS) arterial line protocol was initiated.
Aims: To compare the duration of arterial line patency and incidence of bleeding complications in LDHS versus control patients.
Methods: All adult COVID-19 positive patients admitted to an ICU from March 20 to May 25, 2020 with documented thrombosis of an arterial line were included. LDHS patients had heparinized saline administered through an arterial line pressure bag at 10 units/hour. Historical control patients had at least one documented episode of arterial line thrombosis prior to the introduction of the institutional LDHS protocol. Duration of arterial line patency and bleeding complication rates were compared using Wilcoxon test and Fisher’s exact test, respectively. Kaplan Meier and Cox regression were performed with arterial line thrombosis as the endpoint.
Results: Thirty patients received the LDHS protocol, compared to 41 controls. LDHS and control patients were similar in age (61 versus 54 years; p=0.24), male sex (60% versus 61%; p=1.00), presence of thrombotic risk factors (57% versus 66%; p=0.47), median Sequential Organ Failure Assessment Score (6 versus 7; p=0.67), and systemic anticoagulation (47% versus 32%, p= 0.32). The median duration of arterial line patency in LDHS patients was significantly longer than in controls (8.5 versus 2.9 days; p< 0.001) (Table 1, stratified by anticoagulation). Cox regression showed the LDHS protocol to be independently protective against thrombosis (HR 0.13, 95% CI 0.05-0.34; P< 0.001). Kaplan Meier curves were significantly different by log rank test (Figure 1) (p< 0.0001). Incidence of bleeding complications was similar between LDHS and control patients (13% versus 10%, p=0.71).
Conclusions: A LDHS protocol was associated with clinically significant improvement in duration of arterial line patency in COVID-19 patients, without increased risk of bleeding.
|Therapeutic Anticoagulation||No Therapeutic Anticoagulation|
|Outcome||Low Dose Heparin (N=14)||Controls (N= 13)||P value||Low Dose Heparin (N=16)||Controls (N= 28)||P value|
|Arterial line patency duration, median days (IQR)||13.9 (9.3, 18.3)||4.1 (1.0, 10.1)||P<0.001||4.9 (3.3, 8.5)||2.2 (0.7, 6.1)||P=0.026|
|Bleeding Complications||3 (21.4%)||2 (15.4%)||P=1.00||1 (6.3%)||2 (7.1%)||P=1.00|
|Clinically Relevant Non-Major||3||1||—||0||0||—|
|Death||2 (14.3%)||4 (30.8%)||P=0.38||4 (25.0%)||6 (21.4%)||P=1.00|
[Table 1: Outcomes]
To cite this abstract in AMA style:Maurer L, Luckhurst C, Hamidi A, Newman K, Barra M, El Hechi M, Mokhtari A, Breen K, Lux L, Prout L, Lee J, Bittner E, Chang D, Kaafarani H, Roberts R, Rosovsky R. A Low Dose Heparin Protocol Is Associated with Improved Duration of Arterial Line Patency in Critically Ill COVID-19 Patients [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/a-low-dose-heparin-protocol-is-associated-with-improved-duration-of-arterial-line-patency-in-critically-ill-covid-19-patients/. Accessed March 3, 2021.
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