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[Hemodialysis of uremic patients with a high risk of bleeding]
Sixty-three hemodialyses (HD) in 12 uremic patients with a high risk of bleeding were performed successfully. Sixty HD in 9 cases were done with low dose heparinization. An activated whole blood coagulation time (ACT) between 150 and 180 seconds was maintained during HD. Of these 60 HD, 54 were done in 5 patients with pericarditis, 4 were done in 2 patients with serious gastrointestinal (GI) bleeding and 2 were done in 2 patients with postoperative fresh wounds. Heparin-free dialysis was done once in each of 3 patients. Both blood tubing and hemodialyzer were flushed with physiologic saline periodically in one patient with normal ACT, who was a patient with postoperative fresh wound. But these were not flushed in two patients with remarkably prolonged ACT. Of these patients, the first one was with postoperative fresh wound and the second was with serious bleeding in the GI tract. Our experience shows that low dose heparinization or heparin-free dialysis are suitable for uremic patients with high risk of bleeding.
Sixty-three hemodialyses (HD) in 12 uremic patients with a high risk of bleeding were performed successfully. Sixty HD in 9 cases were done with low dose heparinization. An activated whole blood coagulation time (ACT) between 150 and 180 seconds was maintained during HD. Of these 60 HD, 54 were done in 5 patients with pericarditis, 4 were done in 2 patients with serious gastrointestinal (GI) bleeding and 2 were done in 2 patients with postoperative fresh wounds. Heparin-free dialysis was done once in each of 3 patients. Both blood tubing and hemodialyzer were flushed with physiologic saline periodically in one patient with normal ACT, who was a patient with postoperative fresh wound. But these were not flushed in two patients with remarkably prolonged ACT. Of these patients, the first one was with postoperative fresh wound and the second was with serious bleeding in the GI tract. Our experience shows that low dose heparinization or heparin-free dialysis are suitable for uremic patients with high risk of bleeding.