Anticoagulation during haemodialysis in patients at high-risk of bleeding

Routine haemodialysis is performed with systemic anticoagulation, usually with heparin, to prevent thrombosis in the extracorporeal blood circuit. However, systemic anticoagulation can produce haemorrhagic complications in patients at high risk of bleeding. To minimize the risk of bleeding, a number of alternative regimens have been proposed: regional heparinization with protamine reversal; minimal heparinization; no heparin with saline flushes; regional anticoagulation with citrate; or prostacyclin anticoagulation. Although the incidence of bleeding complications has been reduced, each of these methods has its own limitations and complications. Among the types of membrane used in dialysers, cellulose membranes have been made more biocompatible by attaching N,N-diethyl-aminoehtyl (DEAE) groups to cellulose backbone. Positively charged DEAE groups on Hemophan enable negative charged heparin to be bound with the membrane. Haemodialysis using heparin-bound Hemophan has been reported to be a possible modality for patients at risk of bleeding. We designed more simplified heparin binding technique and have performed haemodialysis using heparin-bound Hemophan in patients at risk of bleeding during the past 7 years. In this review, current strategies to minimize bleeding complications and our experience of haemodialysis using heparin-bound Hemophan will be discussed.