| [ Summary ] |
To prevent clotting in extracorporeal circuits during hemodialysis, anticoagulant treatment is mandatory. Unfractionated heparin, low-molecular-weight heparin, heparinoids (danaparoid and fondaparinux), trombin inhibitors (argatroban), nafamostat mesilate, trisodium citrate and heparin-free dialysis are the choices of anticoagulation techniques. In the United Stetes and Japan, unfractionated heparin is primarily used, whereas in Europe, low-molecular-weight heparin is the most common choice. Low-molecular-weight heparin has been shown to be safe and effective, producing fewer adverse effects such as hyperlipidemia, hyperkalemia or osteoporosis, compared with unfractionated heparin. It is important to note that low-molecular-weight heparin has a longer half-life than unfractionated heparin, and the anticoagulant effects of low-molecular-weight heparin can be blocked only partially by protamine, making low-molecular-weight heparin more dangerous for patients at high risk of bleeding. Trisodium citrate and heparin-free dialysis are the traditional options for patients at high risk of bleeding. Nafamostat mesilate is an excellent anticoagulation option because of its extremely short half-life (8 minutes) and high adjustability. For those with heparin-induced thrombocytopenia, heparinoids, hirudidin or citrate anticoagulation are recommended, but nafamostat mesilate is also safe to use. |