| [ Summary ] |
At present, an unfractionated heparin (UFH), low-molecular-weight heparins (LMWHs) and nafamostat mesilate (NM) are mainly used as anticoagulants in hemodialysis (HD), and it is thought to be important to appropriately select them according to the condition of the HD patient, for safer treatment. UFH, for which the half- life in plasma is for 1 to 2 hours, is continuously infused to obtain stable anticoagulant effects with constant anti-factor Xa activity and prolongation of activated partial thromboplastin times during HD. LMWH, with a longer half-life of approximately for 4 hours, can be administered by bolus injection for its total dosage in HD patients, without any hemorrhagic episodes, while it should be administered only by continuous infusion in patients with bleeding disorders or bleeding tendencies. LMWH can be monitored by its anti-factor Xa activity-based as says such as specific chromogenic methods. NM can be administered to patients with high risk of bleeding, as a regional anticoagulant, that works only in an extracorporal circuit, due to its short activity time. The effect of NM is monitored through observing activated coagulation times, which demonstrate a positive correlation with NM blood levels. |