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Review: anticoagulation for haemodialysis
Michael Suranyi1, Josephine S F Chow
1Liverpool Hospital, Area Director Renal Services, Sydney South West Area Health Service, Western Zone, Sydney, New South Wales, Australia. michael.suranyi@sswahs.nsw.gov.au
Nephrology (Carlton, Vic.)
|July 9, 2010
Summary
Dialysis activates blood clotting, requiring anticoagulation. Heparin is common, but heparin-induced thrombocytopaenia (HIT) necessitates alternative anticoagulants for safe dialysis.
Area of Science:
- Nephrology
- Hematology
- Biomedical Engineering
Background:
- Dialysis membranes and lines activate the coagulation cascade, necessitating anticoagulation for safe and effective treatment.
- Unfractionated heparin (UF heparin) and low-molecular-weight heparin (LMWH) are primary anticoagulants in hemodialysis.
- Heparin-induced thrombocytopaenia (HIT) Type II is a serious complication, particularly with UF heparin, requiring heparin-free anticoagulation strategies.
Purpose of the Study:
- To review the complexities of anticoagulation in hemodialysis.
- To highlight the risks and management of heparin-induced thrombocytopaenia (HIT) Type II.
- To discuss alternative anticoagulation methods for dialysis patients.
Main Methods:
- Review of current clinical practices in hemodialysis anticoagulation.
- Analysis of the mechanisms and complications of heparin use in dialysis.
- Exploration of alternative anticoagulant agents and strategies.
Main Results:
- Dialysis inherently promotes blood coagulation through intrinsic and extrinsic pathways, and platelet activation.
- HIT Type II, a severe complication, occurs more frequently with UF heparin than LMWH.
- Management of HIT Type II requires heparin cessation and alternative anticoagulation, posing treatment challenges.
Conclusions:
- Effective anticoagulation is crucial for safe hemodialysis, with careful consideration of heparin risks.
- Emerging anticoagulants offer alternatives for patients at risk of or experiencing HIT.
- Regular updates in dialysis anticoagulation knowledge are essential for clinicians to ensure optimal patient care.
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