Pharmacodynamics of Unfractionated Heparin During and After a Hemodialysis Session

Brunet, Philippe; Simon, Nicolas; Opris, Adriana; Faure, Valérie; Lorec-Pénet, Anne-Marie; Portugal, Henri; Dussol, Bertrand; Berland, Yvon

doi:10.1053/j.ajkd.2007.12.040

Cited by 37 publications

(29 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Critically, one pharmacodynamic study showed that, among patients treated with standard heparin protocols, anti–factor Xa levels were undetectable (<0.1 IU/mL) at 120 minutes after dialysis in hemodialysis patients treated with 4 hours of heparin during dialysis, suggesting that PTT may not be the optimal measure of bleeding risk in this population. 94 Kidney Disease Outcomes Quality Initiative guidelines from 2005 take heparin administration during dialysis into account and state that the original stipulation of excluding patients who have received heparin in the previous 48 hours was not designed to address patients on intermittent dialysis and that use of tPA for ischemic stroke should be considered on an individual patient basis. 95 …”

Section: Acute Treatment Of Ischemic Strokementioning

confidence: 99%

Stroke and Chronic Kidney Disease: Epidemiology, Pathogenesis, and Management Across Kidney Disease Stages

Dad

Weiner

2015

Seminars in Nephrology

View full text Add to dashboard Cite

Summary Cerebrovascular disease and stroke are very common at all stages of chronic kidney disease (CKD), likely representing both shared risk factors as well as synergy among risk factors. More subtle ischemic brain lesions may be particularly common in the CKD population, with subtle manifestations including cognitive impairment. For individuals with nondialysis CKD, the prevention, approach to, diagnosis, and management of stroke is similar to the general, non-CKD population. For individuals with end-stage renal disease, far less is known regarding the prevention of stroke. Stroke prophylaxis using warfarin in dialysis patients with atrial fibrillation in particular remains of uncertain benefit. End-stage renal disease patients can be managed aggressively in the setting of acute stroke. Outcomes after stroke at all stages of CKD are poor, and improving these outcomes should be the subject of future clinical trials.

show abstract

Section: Acute Treatment Of Ischemic Strokementioning

confidence: 99%

Stroke and Chronic Kidney Disease: Epidemiology, Pathogenesis, and Management Across Kidney Disease Stages

Dad

Weiner

2015

Seminars in Nephrology

View full text Add to dashboard Cite

show abstract

“…The half-life of UFH is about 1 hour in patients with kidney failure (vs 30 minutes in patients with normal kidney function), but other facets of hemodialysis, including dialyzer type and dose of erythropoietin, also can affect its activity. 4,18-23 …”

Section: Pharmacologymentioning

confidence: 99%

“…28 A continuous or hourly intermittent infusion often follows, which provides more consistent levels of anticoagulation (and presumably less risk of bleeding) than a single second bolus. 4,30 The hourly rate can range from 500-2,000 IU/h or more, depending on the dose of the initial bolus, and some centers avoid all heparin in the final hour of dialysis to decrease the likelihood of bleeding at the needle sites. 4,31 Many dialysis units use weight-based dosing protocols, but interpatient variability in heparin elimination makes these protocols only marginally better at achieving consistent levels of anticoagulation than fixed doses, except at the extremes of weight.…”

Section: Dosing Schedulesmentioning

confidence: 99%

See 1 more Smart Citation

Use and Safety of Unfractionated Heparin for Anticoagulation During Maintenance Hemodialysis

Shen

Winkelmayer

2012

American Journal of Kidney Diseases

View full text Add to dashboard Cite

Anticoagulation is essential to hemodialysis, and unfractionated heparin (UFH) is the most commonly used anticoagulant in the United States. However, there is no universally accepted standard for its administration in long-term hemodialysis. Dosage schedules vary and include weight-based protocols and low-dose protocols for those at high risk of bleeding, as well as regional anticoagulation with heparin and heparin-coated dialyzers. Adjustments are based largely on clinical signs of under- and overanticoagulation. Risks of UFH use include bleeding, heparin-induced thrombocytopenia, hypertriglyceridemia, anaphylaxis, and possibly bone mineral disease, hyperkalemia, and catheter-associated sepsis. Alternative anticoagulants include low-molecular-weight heparin, direct thrombin inhibitors, heparinoids, and citrate. Anticoagulant-free hemodialysis and peritoneal dialysis also are potential substitutes. However, some of these alternative treatments are not as available as or are more costly than UFH, are dependent on country and health care system, and present dosing challenges. When properly monitored, UFH is a relatively safe and economical choice for anticoagulation in long-term hemodialysis for most patients.

show abstract

“…This may reflect a general disregard for strict adherence to guidelines by stroke experts, although actual treatment of acute stroke patients with recent heparin/high aPTT appears to be rare (15). The metabolism of unfractionated heparin is relatively rapid after hemodialysis (16), and repeating the aPTT after 1 to 2 hours may be a sensible option for clinicians who are reluctant to violate guideline recommendations, if thrombolysis can still be administered within accepted time restrictions. Several experts commented that "time is brain" in justifying immediate thrombolysis despite the prolongation of the aPTT in Case #1.…”

Section: Discussionmentioning

confidence: 99%

Thrombolysis for Acute Stroke in Hemodialysis

Palacio

Gonzales

Sangha

et al. 2011

Clinical Journal of the American Society of Nephrology

View full text Add to dashboard Cite

SummaryBackground and objectives Although data are absent, it has been stated that thrombolysis is probably not safe in the treatment of acute stroke in patients undergoing hemodialysis. The objective of this study was for stroke experts to define the range of management concerning thrombolytic treatment of acute stroke in hemodialysis.Design, setting, participants, & measurements Sixty-five stroke experts in thrombolytic therapy of acute ischemic stroke were queried regarding their personal experience in the use of thrombolysis in hemodialysis patients. Hypothetical case scenarios were presented. ResultsOf the 65 stroke experts who were queried, 40 (62%) responded. One-third of the responders had previously treated hemodialysis patients with recombinant tissue-type plasminogen activator (rt-PA). Most favored use of intravenous rt-PA for hemodialysis patients with acute ischemic stroke. When presented with a case of a patient who had recently undergone dialysis with a mildly prolonged activated partial thromboplastin time (aPTT), 50% favored immediate intravenous thrombolysis. Seventy-eight percent of the experts would have considered an intra-arterial approach and would have preferred mechanical clot retrieval to thrombolysis. ConclusionsDespite the acknowledged absence of data and prevalent concerns about bleeding risk, most surveyed experts favored its use. One-third reported treating hemodialysis patients with this therapy. Although these results do not substitute for data, they usefully define the range of current practice of stroke experts.

show abstract

Pharmacodynamics of Unfractionated Heparin During and After a Hemodialysis Session

Cited by 37 publications

References 14 publications

Stroke and Chronic Kidney Disease: Epidemiology, Pathogenesis, and Management Across Kidney Disease Stages

Stroke and Chronic Kidney Disease: Epidemiology, Pathogenesis, and Management Across Kidney Disease Stages

Use and Safety of Unfractionated Heparin for Anticoagulation During Maintenance Hemodialysis

Thrombolysis for Acute Stroke in Hemodialysis

Contact Info

Product

Resources

About