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The safety of heparins in end-stage renal disease.
Semin Dial. 2006 Jul-Aug; 19(4):305-10.SD

Abstract

In patients on chronic dialysis, unfractionated heparin (UFH) is the most commonly used agent for anticoagulation of the hemodialysis extracorporeal circuit, for hemodialysis catheter "locking" between dialysis treatments, and for nondialysis indications such as venous thromboembolic disease, peripheral vascular disease, and acute coronary artery disease. Potentially serious complications of UFH, such as hemorrhage, osteoporosis, and thrombocytopenia, have led to consideration of other options for anticoagulation, including low molecular weight heparin (LMWH) and direct thrombin inhibitors (DTIs). LMWH can be used for anticoagulation of the hemodialysis circuit, but whether this has significant benefit compared to UFH remains to be proven. Because of the somewhat unpredictable risk of severe bleeding complications when LMWH is used for other indications in dialysis patients, UFH rather than LMWH is preferred for treatment of thromboembolic disease in these patients. DTIs have been used for anticoagulation in dialysis patients with heparin-induced thrombocytopenia (HIT), with argatroban being the preferred agent if heparin-free hemodialysis cannot be performed. UFH still remains the preferred anticoagulant in the vast majority of dialysis patients requiring systemic anticoagulation and for anticoagulation of the extracorporeal hemodialysis circuit.

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Authors+Show Affiliations

Sonawane S
Department of Medicine, Renal, Electrolyte, and Hypertension Division, Penn Presbyterian Medical Center, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA.
Kasbekar N
No affiliation info available
Berns JS
No affiliation info available

MeSH

AnticoagulantsHeparinHeparin, Low-Molecular-WeightHumansKidney Failure, ChronicRenal DialysisThrombinThrombosis

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

16893408

Citation

Sonawane, Samsher, et al. "The Safety of Heparins in End-stage Renal Disease." Seminars in Dialysis, vol. 19, no. 4, 2006, pp. 305-10.
Sonawane S, Kasbekar N, Berns JS. The safety of heparins in end-stage renal disease. Semin Dial. 2006;19(4):305-10.
Sonawane, S., Kasbekar, N., & Berns, J. S. (2006). The safety of heparins in end-stage renal disease. Seminars in Dialysis, 19(4), 305-10.
Sonawane S, Kasbekar N, Berns JS. The Safety of Heparins in End-stage Renal Disease. Semin Dial. 2006 Jul-Aug;19(4):305-10. PubMed PMID: 16893408.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The safety of heparins in end-stage renal disease. AU - Sonawane,Samsher, AU - Kasbekar,Nishaminy, AU - Berns,Jeffrey S, PY - 2006/8/9/pubmed PY - 2006/12/21/medline PY - 2006/8/9/entrez SP - 305 EP - 10 JF - Seminars in dialysis JO - Semin Dial VL - 19 IS - 4 N2 - In patients on chronic dialysis, unfractionated heparin (UFH) is the most commonly used agent for anticoagulation of the hemodialysis extracorporeal circuit, for hemodialysis catheter "locking" between dialysis treatments, and for nondialysis indications such as venous thromboembolic disease, peripheral vascular disease, and acute coronary artery disease. Potentially serious complications of UFH, such as hemorrhage, osteoporosis, and thrombocytopenia, have led to consideration of other options for anticoagulation, including low molecular weight heparin (LMWH) and direct thrombin inhibitors (DTIs). LMWH can be used for anticoagulation of the hemodialysis circuit, but whether this has significant benefit compared to UFH remains to be proven. Because of the somewhat unpredictable risk of severe bleeding complications when LMWH is used for other indications in dialysis patients, UFH rather than LMWH is preferred for treatment of thromboembolic disease in these patients. DTIs have been used for anticoagulation in dialysis patients with heparin-induced thrombocytopenia (HIT), with argatroban being the preferred agent if heparin-free hemodialysis cannot be performed. UFH still remains the preferred anticoagulant in the vast majority of dialysis patients requiring systemic anticoagulation and for anticoagulation of the extracorporeal hemodialysis circuit. SN - 0894-0959 UR - https://www.unboundmedicine.com/medline/citation/16893408/The_safety_of_heparins_in_end_stage_renal_disease_ L2 - https://doi.org/10.1111/j.1525-139X.2006.00177.x DB - PRIME DP - Unbound Medicine ER -