Acid-citrate-dextrose Formula A versus heparin as primary catheter lock solutions for therapeutic apheresis

Unfractionated heparin (UFH) is a commonly used catheter lock solution, but may lead to various complications. Acid-citrate-dextrose Formula A (ACD-A), the standard anticoagulant used in therapeutic apheresis (TA), is an alternative. We compared the efficacy of these two anticoagulants as primary catheter lock solutions.

The following outcomes were analyzed retrospectively for all TA procedures performed between July 2009 and March 2012: patent, partial occlusion, total occlusion, catheter-related blood stream infection, tissue plasminogen activator use, and premature catheter removal.

Our primary data set included 5964 total catheter days, 3020 procedures, and 427 TA courses. The UFH group comprised 3444 catheter days and 1880 procedures; the ACD-A group, 2520 catheter days and 1140 procedures. Overall catheter-related outcomes differed by not more than 5.3% for the primary analysis and when stratified by short-term (≤10 days) duration or short dwell times (<3 days). When stratified by long-term duration (>10 days) and long dwell times (>3 days), differences increased to not more than 10.4 and 22.4%, respectively.

For short-term courses and short dwell times, UFH and ACD-A appear equally effective; UFH appears superior to ACD-A in the setting of long-term courses and long dwell times. Major catheter-related complications were rare and occurred with similar frequency in both groups. For most indications, ACD-A appears to be a reasonable alternative to heparin; however, an adequately powered, randomized trial would be required to definitively address this issue.