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Evaluation of Bleeding Rates With Sodium Bicarbonate Versus Heparin-Based Purge Solutions for Impella CP and 5.5
Priya J Patel1, Jesse E Harris1, Kevin R Donahue1
1Houston Methodist Hospital, Houston, Texas, USA.
Background:
Sodium bicarbonate-based purge solution (BBPS) is a growing alternative to heparin-based purge solution (HBPS). However, literature comparing the safety of BBPS to HBPS remains limited. We assessed the safety of HBPS to BBPS in patients with Impella devices by evaluating the rates of major and clinically relevant non-major bleeding (CRNMB).
Methods:
This is a single-center, retrospective cohort study including patients on Impella CP or 5.5 devices maintained on HBPS or BBPS for ≥ 48 h. The primary outcome was a composite of major bleeding and CRNMB. Secondary endpoints included suspected device thrombosis and systemic complications.
Results:
A total of 83 patients met inclusion criteria (48 in the HBPS and 35 in BBPS). There was no difference in the composite incidence of major bleeding and CRNMB between HBPS and BBPS (56.3% vs. 45.7%, p = 0.34) or the incidence of device-related or systemic complications. However, there was a significantly higher incidence of major bleeding in those with an Impella 5.5 receiving HBPS as compared to BBPS (27.3% vs. 4.8%, p = 0.04).
Conclusion:
BBPS may be a safer option in those requiring longer duration of Impella support even in the absence of contraindications to heparin use and offers comparable efficacy to HBPS. The use of BBPS may be a solution towards standardizing and simplifying anticoagulation management in this population. Larger studies are needed to support the durability of Impella devices with BBPS.
