Anticoagulation in Chronic Hemodialysis

Introduction to Anticoagulants

The American College of Chest Physicians recommends heparin as the standard anticoagulant for hemodialysis due to its low cost, proven efficacy, and reversibility 1
The Kidney International society suggests citrato regional as an alternative for patients with high bleeding risk or heparin-induced thrombocytopenia (HIT) 2
Blood advances guidelines recommend citrato regional for patients with HIT, as it provides regional anticoagulation without systemic effects 3

For patients with standard risk, heparin is recommended with an initial bolus of 25-50 UI/kg followed by continuous infusion of 500-1500 UI/hour, according to the Chest guidelines 1
The Blood advances society recommends argatroban, danaparoid, or bivalirudina for patients with acute HIT 4
For patients with high bleeding risk, citrato regional is the preferred alternative, as stated by the Kidney International and Blood advances guidelines 2, 3

The American Journal of Kidney Diseases recommends adjusting dialysis prescription to reduce the risk of hypotension in patients with acute coronary syndrome on hemodialysis 6
Bivalirudina is the preferred anticoagulant for percutaneous coronary intervention in patients on hemodialysis due to its specific dosing recommendations, according to the American Journal of Kidney Diseases guidelines 7, 8
The Kidney International society suggests that anticoagulation during hemodialysis should be individualized based on bleeding risk, comorbidities, and center experience, aiming to balance circuit coagulation prevention and bleeding risk minimization 2