SP477TIN-CAT STUDY: CONVERSION OF UNFRACTIONNED HEPARIN TO TINZAPARIN IN HEMODIALYSIS AND ITS IMPACT ON ALTEPLASE (CATHFLO) UTILIZATION
Bibliographic record
Abstract
INTRODUCTION AND AIMS: Catheter dysfunction is a major contributor of suboptimal dialysis efficacy in chronic hemodialysis (HD) patients. The use of alteplase as push, dwell or locking solution accounts for a substantial part of the expense of treating HD patients. Compared to unfractionated heparin (UFH), tinzaparin has recently and previously been reported to be as safe and efficacious as UFH for HD anticoagulation as well as being cost-effective. METHODS: We conducted a prospective observational pharmacoeconomic study to evaluate the use and costs of alteplase, 3 months prior to and 3 months after the conversion of UFH to tinzaparin in our 274 intermittent HD patients. Dose titration of tinzaparin for clinically apparent clotting of the HD filter/circuit was documented with the usual staging observations in use at the 4 in-center HD units. Primary outcome was the total number of administered doses and related costs of alteplase prior and post conversion. Secondary outcomes included: a) Dialysis efficacy (Kt/V) ; b) Sessional HD filter/circuit clotting as documented by the HD nurses; c) The impact of filter type on tinzaparin requirement RESULTS: 274 patients dialyzed in 4 dialysis units were switched from UFH to tinzaparin and 213 patients followed prospectively completed the 6 month study. The percentage of patient requiring alteplase was reduced by 3.7% and was not significant (pvalue McNemar test 0.1890). The wilcoxon signed rank test was used to compare the mean number of doses before and after the conversion of UFH to tinzaparin. The mean number of doses of alteplase was reduced by 1.62 (SD=7.5, pvalue signed rank ttest =0.0074). The number of alteplase doses was significantly reduced in 2 dialysis units (pvalue = 0,0074) and there was a trend of reduced utilization in the other 2 dialysis units. The unadjusted incidence rate ratio of zero Inflated Poisson regression was 0.76 95% CI (0.71-0.83) (the number of alteplase used after the switch decreased by 24%). CONCLUSIONS: Conversion of UFH to tinzaparin for intermittent HD patients resulted in a 24% decrease of alteplase use and associated costs for the treatment of catheter dysfunction after only 3 months post conversion resulting in an estimated annual saving of $22,783 (CAN). Further research is warranted to quantify additional cost components associated with anticoagulant administration for hemodialysis, such as the nursing time and other resources required to treat adverse events.This was an unsponsored study.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".