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Filter clotting with continuous renal replacement therapy in COVID-19.

Authors
  • Endres, Paul1
  • Rosovsky, Rachel2
  • Zhao, Sophia1
  • Krinsky, Scott1
  • Percy, Shananssa1
  • Kamal, Omer3
  • Roberts, Russel J4
  • Lopez, Natasha4
  • Sise, Meghan E1
  • Steele, David J R1
  • Lundquist, Andrew L1
  • Rhee, Eugene P1
  • Hibbert, Kathryn A5
  • Hardin, C Corey5
  • Mc Causland, Finnian R3
  • Czarnecki, Peter G3
  • Mutter, Walter6
  • Tolkoff-Rubin, Nina1
  • Allegretti, Andrew S7
  • 1 Division of Nephrology, Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, GRB 1008, Boston, MA, 02114, USA.
  • 2 Division of Hematology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
  • 3 Division of Renal Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
  • 4 Department of Pharmacy, Massachusetts General Hospital, Boston, MA, USA.
  • 5 Division of Pulmonary and Critical Care, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
  • 6 Division of Nephrology, Department of Medicine, Newton Wellesley Hospital, Newton, MA, USA.
  • 7 Division of Nephrology, Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, GRB 1008, Boston, MA, 02114, USA. [email protected]
Type
Published Article
Journal
Journal of Thrombosis and Thrombolysis
Publisher
Springer-Verlag
Publication Date
May 01, 2021
Volume
51
Issue
4
Pages
966–970
Identifiers
DOI: 10.1007/s11239-020-02301-6
PMID: 33026569
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Coronavirus disease 2019 (COVID-19) appears to be associated with increased arterial and venous thromboembolic disease. These presumed abnormalities in hemostasis have been associated with filter clotting during continuous renal replacement therapy (CRRT). We aimed to characterize the burden of CRRT filter clotting in COVID-19 infection and to describe a CRRT anticoagulation protocol that used anti-factor Xa levels for systemic heparin dosing. Multi-center study of consecutive patients with COVID-19 receiving CRRT. Primary outcome was CRRT filter loss. Sixty-five patients were analyzed, including 17 using an anti-factor Xa protocol to guide systemic heparin dosing. Fifty-four out of 65 patients (83%) lost at least one filter. Median first filter survival time was 6.5 [2.5, 33.5] h. There was no difference in first or second filter loss between the anti-Xa protocol and standard of care anticoagulation groups, however fewer patients lost their third filter in the protocolized group (55% vs. 93%) resulting in a longer median third filter survival time (24 [15.1, 54.2] vs. 17.3 [9.5, 35.1] h, p = 0.04). The rate of CRRT filter loss is high in COVID-19 infection. An anticoagulation protocol using systemic unfractionated heparin, dosed by anti-factor Xa levels is reasonable approach to anticoagulation in this population.

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