Review: Anticoagulation in hemodialysis – Refining the conventional and moving forward
Abstract
Anticoagulation is an important requirement in hemodialysis due to the predisposition for extracorporeal thrombosis when whole blood comes into contact with a foreign surface. A no-anticoagulation hemodialysis is typically only practised when a patient who is at risk of hemorrhage requires hemodialysis. The most commonly utilised routine anticoagulation options for hemodialysis are unfractionated heparin (UFH) or low molecular weight heparin (LMWH). Other anticoagulants available include regional citrate and several non-heparin agents which are typically used in heparin-induced thrombocytopenia (HIT) syndrome. HITs is a potentially fatal complication following the use of heparin and its early recognition is crucial. Once diagnosed, all UFH and LMWH should be avoided long term. Novel oral anticoagulants (NOACS) have recently appeared for use in atrial fibrillation and may be seen in some patients on hemodialysis, even though not supported by clinical guidelines or the evidence base. NOACS may provide an exciting platform for hemodialysis anticoagulation in the future, though evidence in hemodialysis remains scarce currently. Cost-benefit remains the most important consideration in determining a choice of anticoagulant for hemodialysis. Further trials will be required to guide the decision-making process in the use of emerging anticoagulants in hemodialysis.
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Suranyi MG, Chow JS. Review: anticoagulation for haemodialysis. Nephrology (Carlton). 2010;15(4):386-92.
Davenport A. What are the anticoagulation options for intermittent hemodialysis? . Nature Reviews Nephrology. 2011;7:499-508.
Shen J, Mitani, AA, Chang, TI, Winkelmayer, WC. Use and safety of heparin-free maintenance hemodialysis in the USA. Nephrology Dialysis Transplantation. 2013;28(6):1589-602.
Sanders P, Taylor, H, Curtis, JJ. Hemodialysis without anticoagulation. American Journal of Kidney Diseases. 1985;V(1):32-5.
Dager WET, Laura V.; Pon, Tiffany K. Considerations for systemic anticoagulation in ESRD. Seminars in Dialysis. 2015;28(4):354-62.
Cronin RE, Reilly, Robert F. Unfractionated heparin for hemodialysis: Still the best option. Seminars in Dialysis. 2010;23(5):510-5.
Brunet P, Simon N, Opris A, Faure V, Lorec-Penet A-M, Portugal H, et al. Pharmacodynamics of unfractionated heparin during and after a hemodialysis session. American Journal of Kidney Diseases. 2008;51(5):789-95.
van Veen JJ, Maclean RM, Hampton KK, Laidlaw S, Kitchen S, Toth P, et al. Protamine reversal of low molecular weight heparin: clinically effective? Blood Coagul Fibrinolysis. 2011;22(7):565-70.
Davenport A. The rationale for the use of low molecular weight heparin for hemodialysis treatments. Hemodialysis International. 2013;17:S28-S32.
Guillet B, Simon N, Sampol JJ, Lorec-Penet AM, Portugal H, Berland Y, et al. Pharmacokinetics of the low molecular weight heparin enoxaparin during 48h after bolus administration as an anticoagulant in haemodialysis. Nephrology Dialysis Transplantation. 2003;18(11):2348-53.
Kessler M, Moureau F, Nguyen P. Anticoagulation in chronic hemodialysis: progress toward an optimal approach. Seminars in Dialysis. 2015;28(5):474-89.
Lazrak HH, René É, Elftouh N, Leblanc M, Lafrance J-P. Safety of low-molecular-weight heparin compared to unfractionated heparin in hemodialysis: a systematic review and meta-analysis. BMC Nephrology. 2017;18:187.
Lim W, Cook DJ, Crowther MA. Safety and efficacy of low molecular weight heparins for hemodialysis in patients with end-stage renal failure: a meta-analysis of randomized trials. Journal of the American Society of Nephrology. 2004;15(12):3192-206.
Saltissi D, Morgan, C., Westhuyzen, J., Healy, H. Comparison of low-molecular-weight heparin (enoxaparin sodium) and standard unfractionated heparin for haemodialysis anticoagulation. Nephrology Dialysis Transplantation. 1999;14(11):2698-703.
Mollison PL. The Introduction of Citrate as an Anticoagulant for Transfusion and of Glucose as a Red Cell Preservative. British Journal of Haematology. 2000;108(1):13-8.
Faguer S, Saint-Cricq M, Nogier M-B, Labadens I, Lavayssiere L, Kamar N, et al. Heparin-free prolonged intermittent hemodialysis using calcium-free citrate dialysate in critically ill patients. Critical Care Medicine. 2017;45(11):1887-92.
Morgera S. Survival benefit with regional anticoagulation with citrate in CRRT: the end of a myth? Nephrology Dialysis Transplantation. 2011;26(1):9-11.
Evenepoel P, Dejagere T, Verhamme P, Claes K, Kuypers D, Bammens B, et al. Heparin-coated polyacrylonitrile membrane versus regional citrate anticoagulation: a prospective randomized study of 2 anticoagulation strategies in patients at risk of bleeding. American Journal of Kidney Diseases. 2007;49(5):642-9.
Wright S, Steinwandel U, Ferrari P. Citrate anticoagulation using ACD solution A durine long-term haemodialysis Nephrology. 2011;16(4):396-402.
Tran H, Joseph J, Young L, McRae S, Curnow J, Nandurkar H, et al. New oral anticoagulants: a practical guide on prescription, laboratory testing and peri-procedural/bleeding management. Intern Med J. 2014;44(6):525-36.
Mavrakanas TA, Samer CF, Nessim SJ, Frisch G, Lipman ML. Apixaban Pharmacokinetics at Steady State in Hemodialysis Patients. Journal of the American Society of Nephrology. 2017;28(7):2241-8.
Chan KE, Edelman ER, Wenger JB, Thadhani RI, Maddux FW. Dabigatran and Rivaroxaban Use in Atrial Fibrillation Patients on Hemodialysis. Circulation. 2015;131(11):972-9.
Chan KE, Giugliano RP, Patel MR, Abramson S, Jardine M, Zhao S, et al. Nonvitamin K Anticoagulant Agents in Patients With Advanced Chronic Kidney Disease or on Dialysis With AF. Journal of the American College of Cardiology. 2016;67(24):2888-99.
Pollack CVJ, Reilly PA, van Ryn J, Eikelboom JW, Glund S, Bernstein RA, et al. Idarucizumab for Dabigatran Reversal — Full Cohort Analysis. New England Journal of Medicine. 2017;377(5):431-41.
Connolly SJ, Milling TJJ, Eikelboom JW, Gibson CM, Curnutte JT, Gold A, et al. Andexanet Alfa for Acute Major Bleeding Associated with Factor Xa Inhibitors. New England Journal of Medicine. 2016;375(12):1131-41.
Brown P, Jay R, Fox A, Oliver M. Chronic fondaparinux use in a hemodialysis patient with heparin-induced thrombocytopenia type II and extracorporeal circuit thrombosis—a case report and review of the literature. Hemodial International. 2013;17(3):444-9.
Favaloro EJ, McCaughan G, Pasalic L. Clinical and laboratory diagnosis of heparin induced thrombocytopenia: an update. Pathology. 2017;49(4):346-55.
Lo GK, Juhl D, Warkentin TE, Sigouin CS, Eichler P, Greinacher A. Evaluation of pretest clinical score (4 T's) for the diagnosis of heparin‐induced thrombocytopenia in two clinical settings. Journal of Thrombosis and Haemostasis. 2006;4(4):759-65.
O'Shea SI, Sands JJ, Nudo SA, Ortel TL. Frequency of anti-heparin-platelet factor 4 antibodies in hemodialysis patients and correlation with recurrent vascular access thrombosis. American Journal of Hematology. 2002;69(1):72-3.
O'Shea SI, Ortel TL, Kovalik EC. Alternative methods of anticoagulation for dialysis-dependent patients with heparin-induced thrombocytopenia. Semin Dial. 2003;16(1):61-7.
Tang IY, Cox DS, Patel K, Reddy BV, Nahlik L, Trevino S, et al. Argatroban and Renal Replacement Therapy in Patients with Heparin-Induced Thrombocytopenia. Annals of Pharmacotherapy. 2005;39(2):231-6.
Elmore LH, Leslie. Argatroban for the treatment of heparin-induced thrombocytopenia in end stage renal disease and acute kidney injury. Tennessee Medicine E-Journal. 2015;1(3).
Al-Ali FS, Elsayed M, Khalifa S, Abdulla AE, Tolba H, Bouanane H, et al. Successful use of a bivalirudin treatment protocol to prevent extracorporeal thrombosis in ambulatory hemodialysis patients with heparin-induced thrombocytopenia. Hemodialysis International. 2016;20(2):204 - 7.
Magnani HN. A review of 122 published outcomes of danaparoid anticoagulation for intermittent haemodialysis. Thrombosis Research. 2010;125(4):e171-e6.
Speeckaert MM, Devreese KMJ, Vanholder RC, Dhondt A. Fondaparinux as an alternative to vitamin K antagonists in haemodialysis patients. Nephrology Dialysis Transplantation. 2013;17(3):3090-5.
DOI: http://dx.doi.org/10.18103/imr.v4i3.672
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