Document Detail


Essentials of anticoagulation in hemodialysis.
MedLine Citation:
PMID:  17403168     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Numerous acquired hemostatic abnormalities have been identified in renal insufficiency. Hemodialysis procedures add to these disturbances as they repetitively imply turbulent blood flow, high shear stress, and contact of blood to artificial surfaces. This nonphysiological environment leads to activation of platelets, leukocytes, and the coagulation cascade, resulting in fouling of the membrane and ultimately in clotting of fibers and the whole hemodialyzer. Anticoagulation in hemodialysis is targeted to prevent this activation of coagulation during the procedure. Most agents inhibit the plasmatic coagulation cascade. Still commonly used is unfractionated heparin, followed by low-molecular-weight heparin preparations with distinct advantages. Immune-mediated heparin-induced thrombocytopenia constitutes a potentially life-threatening complication of heparin therapy requiring immediate switch to nonheparin alternative anticoagulants. Danaparoid, lepirudin, and argatroban are currently being used for alternative anticoagulation, all of which possess both advantages and limitations. In the past, empirical strategies reducing or avoiding heparin were applied for patients at bleeding risk, whereas nowadays regional citrate anticoagulation is increasingly used to prevent bleeding by allowing procedures without any systemic anticoagulation. Avoidance of clotting within the whole hemodialyzer circuit is not granted. Specific knowledge of the mechanisms of coagulation, the targets of the anticoagulants in use, and their respective characteristics constitutes the basis for individualized anticoagulation aimed at achieving full patency of the circuit throughout the procedure. Patency of the circuit is an important prerequisite for optimal hemodialysis quality.
Authors:
Karl-Georg Fischer
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Hemodialysis international. International Symposium on Home Hemodialysis     Volume:  11     ISSN:  1492-7535     ISO Abbreviation:  Hemodial Int     Publication Date:  2007 Apr 
Date Detail:
Created Date:  2007-04-03     Completed Date:  2007-06-14     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101093910     Medline TA:  Hemodial Int     Country:  Canada    
Other Details:
Languages:  eng     Pagination:  178-89     Citation Subset:  IM    
Affiliation:
Department of Medicine, Division of Nephrology and General Medicine, University Hospital Freiburg, Freiburg, Germany. karl-georg.fischer@uniklinik-freiburg.de
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MeSH Terms
Descriptor/Qualifier:
Anticoagulants / adverse effects,  therapeutic use*
Blood Coagulation / drug effects
Chondroitin Sulfates
Dermatan Sulfate
Equipment Failure
Hemorrhage / chemically induced
Heparin
Heparitin Sulfate
Hirudins
Humans
Pipecolic Acids
Recombinant Proteins
Renal Dialysis / methods*
Renal Insufficiency, Chronic / complications,  therapy
Chemical
Reg. No./Substance:
0/Anticoagulants; 0/Hirudins; 0/Pipecolic Acids; 0/Recombinant Proteins; 0/lepirudin; 24967-94-0/Dermatan Sulfate; 74863-84-6/argatroban; 83513-48-8/danaproid; 9005-49-6/Heparin; 9007-28-7/Chondroitin Sulfates; 9050-30-0/Heparitin Sulfate

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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