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Anticoagulants and extracorporeal circuits
R J Beijering1, H ten Cate, M T Nurmohamed
1Center for Hemostasis, Thrombosis, Atherosclerosis, and Inflammation Research, AMC, University of Amsterdam, The Netherlands.
Seminars in Thrombosis and Hemostasis
|January 1, 1997
Summary
Low-molecular-weight heparins (LMWHs) offer effective and safe anticoagulation for hemodialysis, reducing the need for lab monitoring. Other anticoagulants are being explored for extracorporeal circuits like cardiopulmonary bypass surgery.
Area of Science:
- Pharmacology
- Cardiovascular Medicine
- Nephrology
Background:
- Anticoagulants are essential for maintaining blood flow in extracorporeal circuits.
- Various anticoagulants are in clinical use or preclinical development for these applications.
Purpose of the Study:
- To review anticoagulants used in extracorporeal circuits, focusing on hemodialysis and cardiopulmonary bypass surgery.
- To compare the efficacy and safety of different anticoagulant options.
Main Methods:
- Literature review of anticoagulants in clinical use and preclinical phases.
- Discussion of anticoagulants in hemodialysis and cardiopulmonary bypass surgery.
Main Results:
- Low-molecular-weight heparins (LMWHs) are as effective and safe as standard heparin (SH) in hemodialysis, with benefits of single dose and no lab control.
- Newer agents like dermatan sulfate and hirudin show promise but lack long-term data.
- Heparin-coated circuits in cardiopulmonary bypass surgery (CPB) reduce systemic heparin requirements.
Conclusions:
- LMWHs present advantages for hemodialysis anticoagulation.
- Further investigation is needed for LMWH and other anticoagulants in cardiopulmonary bypass surgery.
- LMW heparinoids offer an alternative for patients with heparin-induced thrombocytopenia.