Abstract 12727: Ultrafiltration for Decompensated Heart Failure Using Aquadex® Without Heparin

Abstract

Introduction: Anticoagulation therapy is necessary during ultrafiltration (UF) to prevent thrombus formation during the filtering process. Heparin is the anticoagulating agent recommended by Aquadex®. However, many patients are already within a therapeutic INR range due to warfarin anticoagulation. Here we present a unique case of Aquadex® UF without the use of heparin anticoagulation. Case Presentation: An 87-year-old male with a history of LVAD implant experienced 2 weeks of weight gain and dyspnea on exertion and at rest due to fluid retention despite GDMT and escalation of oral diuretics. On admission, physical exam revealed elevated JVP, ascites, and 3+ bilateral lower extremity pitting edema and 32 pounds weight gain. He was on a home dose of warfarin per LVAD protocol. Investigations revealed INR 2.9, HCT 29.6, BUN 58, and Cr 2.05. Aquadex® UF was initiated with a therapeutic INR range of 2-3. The patient tolerated UF well without complication and was transitioned back to oral diuretics after 4 days of UF, 24 pounds of weight loss, and 7 liters of fluid removal. He was stable at discharge, but was readmitted two weeks later with identical symptoms and INR 1.9, HCT 26, BUN 32, and Cr 1.69. Aquadex® UF was again initiated with a therapeutic INR range 1.5-2. He again tolerated UF well without complication for 4 days, lost 28 pounds, and had 8.9 liters of fluid removed on this second admission. Aquadex® fluid removal during both hospitalizations is depicted in Figure 1. Conclusions: Our case supports the utilization of UF without the use of heparinization on patients who are already anticoagulated with warfarin. Further, successful UF without clotting complications is possible in INR ranges between 1.5-2 and 2-3 as evidenced during the two hospitalizations. Figure 1. INR levels were maintained within therapeutic ranges using warfarin anticoagulation during Aquadex® UF.