A comparison of clotting rate during hemodialysis in COVID-19 Patients Receiving Anticoagulant vs. No Anticoagulant in an Inpatient Setting

Background: Anticoagulant use during hemodialysis is a standard practice in both outpatients and inpatients setting. In an inpatient setting with heightened acuity of illness, the potential for bleeding attributable to anticoagulant is concerning. Hospitals have started applying an anticoagulant free HD protocol with success. COVID-19 patients showed a degree of systemic hypercoagulability with unique features, including a consumptive disseminated intravascular coagulation coexisting with hyperfibrinolysis and increased bleeding risk. Maintaining circuit patency and avoiding bleeding risk has been challenging. Data regarding anticoagulant in COVID-19 patients who received hemodialysis is limited. This study's primary objective is to compare hemodialysis clotting rate in COVID-19 patients who received anticoagulant versus those without anticoagulant. Methods: Retrospective chart review for all COVID-19 patients who received hemodialysis at Banner Medical Center Tucson Campus Between November 2020 and January 2021. Primary outcome was clotting rate during hemodialysis. CRRT was excluded. Results: 330 total patients observed, 56% sessions in the ICU unit and 44% in the medicine unit. 57% were AKI and 43% were ESRD. Anticoagulant use was 38.5% (heparin IVP during hemodialysis was 12%, continuous systemic heparin was 16% and others (warfarin, DOAC, Argatroban, etc) was 11%). Clotting rate was 12%. Other characteristics can be seen on the table 1. There was no difference in the clotting rate between group with anticoagulant versus without anticoagulant (8% vs.15%, p value 0.06). Multivariable logistic regression for clotting outcome showed that compared to no-anticoagulation, systemic heparin continuous infusion decreased clotting by 83% (OR 0.17, 95% CI 0.04-0.77, p-value=0.02) and others anticoagulant decreased clotting by 91% (OR=0.09, 95% CI 0.01-0.85);compared to AV fistula, temporary dialysis catheter increased clotting by 2.9x (OR 2.9, 95% CI 1.10-7.44, p-value=0.03);and every 10 increase in platelet count increased clotting by 4% (OR 1.04, 95% CI 1.01-1.07, p value =0.01) Conclusions: No anticoagulation and temporary catheters carry high risk for clotting in patients with COVID undergoing iHD. Continuous heparin should be considered.