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Filter clotting with continuous renal replacement therapy in COVID-19
Paul Endres1, Rachel Rosovsky2, Sophia Zhao1
1Division of Nephrology, Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, GRB 1008, Boston, MA, 02114, USA.
Journal of Thrombosis and Thrombolysis
|October 7, 2020
Summary
High rates of filter clotting occur in critically ill COVID-19 patients undergoing continuous renal replacement therapy (CRRT). An anticoagulation protocol using anti-factor Xa levels for heparin dosing showed promise in reducing later filter loss.
Area of Science:
- Nephrology
- Critical Care Medicine
- Hematology
Background:
- Coronavirus disease 2019 (COVID-19) is linked to thromboembolic events.
- Hemostatic abnormalities in COVID-19 may cause filter clotting during continuous renal replacement therapy (CRRT).
Purpose of the Study:
- To assess the frequency of CRRT filter clotting in COVID-19 patients.
- To evaluate a CRRT anticoagulation protocol using anti-factor Xa levels for heparin dosing.
Main Methods:
- Multi-center study of COVID-19 patients receiving CRRT.
- Compared outcomes between an anti-factor Xa guided heparin protocol and standard care.
- Primary outcome: CRRT filter loss.
Main Results:
- 83% of patients lost at least one CRRT filter.
- No significant difference in first or second filter loss between groups.
- The anti-factor Xa protocol group had less third filter loss (55% vs. 93%) and longer third filter survival.
Conclusions:
- CRRT filter loss is a significant issue in COVID-19 patients.
- An anticoagulation protocol guided by anti-factor Xa levels is a viable approach for heparin dosing in this population.
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