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Use and Safety of Unfractionated Heparin for Anticoagulation During Maintenance Hemodialysis
American Journal of Kidney Diseases, 05/09/2012
Clinical Article
Shen JI et al. - Anticoagulant-free hemodialysis and peritoneal dialysis also are potential substitutes. However, some of these alternative treatments are not as available as or are more costly than unfractionated heparin (UFH), are dependent on country and health care system, and present dosing challenges. When properly monitored, UFH is a relatively safe and economical choice for anticoagulation in long-term hemodialysis for most patients.
- Anticoagulation is essential to hemodialysis, and unfractionated heparin (UFH) is the most commonly used anticoagulant in the United States.
- However, there is no universally accepted standard for its administration in long-term hemodialysis.
- Dosage schedules vary and include weight-based protocols and low-dose protocols for those at high risk of bleeding, as well as regional anticoagulation with heparin and heparin-coated dialyzers.
- Adjustments are based largely on clinical signs of under- and overanticoagulation.
- Risks of UFH use include bleeding, heparin-induced thrombocytopenia, hypertriglyceridemia, anaphylaxis, and possibly bone mineral disease, hyperkalemia, and catheter-associated sepsis.
