P-058 - GENDER DIFFERENCES IN RESPONSE TO ADMINISTRATION OF HEPARIN DURING NON-CARDIAC ARTERIAL PROCEDURES

TOPIC:
Medical therapies (antithrombotic, anti-hypertensive, diabetes mellitus etc.)
AUTHORS:
Roosendaal L. (Dijklander Zieknhuis ~ Hoorn ~ Netherlands) , Wiersema A. (Dijklander Zieknhuis ~ Hoorn ~ Netherlands) , Smit J. (Dijklander Zieknhuis ~ Hoorn ~ Netherlands) , Doganer O. (Amsterdam UMC ~ Amsterdam ~ Netherlands) , Blankensteijn J. (Amsterdam UMC ~ Amsterdam ~ Netherlands) , Jongkind V. (Amsterdam UMC ~ Amsterdam ~ Netherlands)
Introduction:
Females are more prone to complications during non-cardiac arterial procedures (NCAP) than males. An explanation for this difference could be variation in heparin sensitivity. The current study investigates the difference in the effect of heparin in males and females, using the activated clotting time (ACT).
Methods:
A retrospective analysis of a prospective multicentre cohort study was performed. All patients undergoing elective NCAP using heparin and ACT measurements between January 2016 and March 2020 were included. Two heparin dosage protocols were used: weight-based dosing: 100 IU/kg and a bolus of 5 000 IU. Primary outcome was the anticoagulatory effect of heparin after 5 minutes, measured by the ACT. Secondary outcomes were the effect of heparin after 30 minutes, bleeding complications and arterial thromboembolic complications (TEC).
Results:
778 patients were included, 26% were female. After 100 IU/kg (n=300), females more often reached high ACT (<200s: 22% versus 25%, p=.62; 200-250s: 41% versus 53%, p=.058; 251-280s, 26% versus 15%, p=.030). The mean ACT after 100 IU/kg of heparin was 233s (95% CI 224-243) for females and 226s (95% CI 221-231) for males (p=.057). After a bolus of 5 000 IU heparin (n=411), females reached significantly higher levels of anticoagulation than males (ACT <200s: 44% versus 66%, p=<.001; 200-250s: 47% versus 30%, p=.001; 251-280s: 7.8% versus 2.3%, p=.009). A significantly higher mean ACT was found for females after 5 000 IU of heparin (204s (95% CI 198-210) versus 190s (95% CI 186-193), p=<.001). Thirty minutes after heparin administration, 58% of all patients had an ACT <200s. TEC did not differ between females and males (6.9% versus 5.1%, p=.33) but bleeding complications were significantly higher in females (27% versus 16% (p=.001)).
Conclusion:
Heparin leads to significant higher ACT values in females during NCAP. Further research is needed to investigate whether a specific heparin protocol for females leads to less bleeding complications without increasing the incidence of TEC.
ATTACHMENTS: