Unfractionated Heparin for Hemodialysis: Still the Best Option
Version of Record online: 29 OCT 2010
© 2010 Wiley Periodicals, Inc.
Seminars in Dialysis
Volume 23, Issue 5, pages 510–515, September/October 2010
How to Cite
Cronin, R. E. and Reilly, R. F. (2010), Unfractionated Heparin for Hemodialysis: Still the Best Option. Seminars in Dialysis, 23: 510–515. doi: 10.1111/j.1525-139X.2010.00770.x
- Issue online: 29 OCT 2010
- Version of Record online: 29 OCT 2010
Unfractionated heparin (UFH) is the anticoagulant of choice for most maintenance hemodialysis units in the United States. Low molecular weight heparin (LMWH) is the norm in Western Europe, but is not approved for this indication in the United States. UFH is likely to remain the agent of choice in the United States because of its relative ease of use, safety, and low cost. Coating tubing and dialyzers with heparin is now possible, but systemic anticoagulation with heparin is usually still required. The additional cost of this innovation does not yet justify its use. Side effects of both UFH and LMWH include heparin-induced thrombocytopenia, hypertriglyceridemia, and hyperkalemia. It is uncertain whether osteoporosis is an important side effect, as vitamin D deficiency, secondary hyperparathyroidism, age, and debility are confounding factors. When UFH poses a risk or its use is contraindicated, e.g., after development of heparin-induced thrombocytopenia, the use of direct thrombin inhibitors, regional citrate anticoagulation, citrate dialysate, and heparin-free dialysis may be appropriate.