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2015 ; 8
(8
): 11985-95
Nephropedia Template TP
gab.com Text
Twit Text FOAVip
Twit Text #
English Wikipedia
Anticoagulant therapies versus heparin for the prevention of hemodialysis
catheter-related complications: systematic review and meta-analysis of
prospective randomized controlled trials
#MMPMID26550111
Liu J
; Wang C
; Zhao H
; Zhang J
; Ma J
; Hou Y
; Zou H
Int J Clin Exp Med
2015[]; 8
(8
): 11985-95
PMID26550111
show ga
Locking of central venous catheters with heparin is an accepted practice to
maintain catheter patency between dialysis sessions. However, this practice may
cause other adverse reactions. Although many studies suggest benefits of other
catheter lock solutions over heparin on these grounds, no consensus has been
reached for clinical practice. A systematic review and meta-analysis was
performed of randomized controlled trials (RCT) that compared
antimicrobial-containing or citrate-alone catheter lock solutions with heparin
alone in patients undergoing hemodialysis with central venous catheters. Medline,
Cochrane Central Register of Controlled Trials from EMBASE, and PubMed were
searched for articles published through June 2014. The primary outcomes were
catheter-related bacteremia (CRB) and catheter malfunction (CM). The secondary
outcomes were bleeding, exit-site infection (ESI), clinical sepsis, and all-cause
mortality. Seventeen RCTs met the inclusion criteria. The meta-analysis showed
that antimicrobial-containing and citrate-alone lock solutions were superior to
heparin for preventing CRB (both P < 0.01). Although antimicrobial-containing
lock solutions significantly affected clinical sepsis (P < 0.01), they did not
affect ESI, bleeding, or all-cause mortality. Incidence of CM episodes was lower
in patients receiving antibiotics + heparin and gentamicin + citrate (both P <
0.05), while other antimicrobial-containing and citrate-alone lock solutions
showed no difference. Only citrate-alone lock solutions significantly decreased
bleeding and ESI episodes (both P < 0.05). Compared with heparin,
antimicrobial-containing lock solutions more effectively prevent CRB and clinical
sepsis. Antibiotics + heparin and gentamicin + citrate solutions showing better
prevention of CM. Citrate-alone lock solutions result in fewer CRB, bleeding and
ESI episodes.