PMID- 36590973
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20230111
IS  - 2296-858X (Print)
IS  - 2296-858X (Electronic)
IS  - 2296-858X (Linking)
VI  - 9
DP  - 2022
TI  - Risk for excessive anticoagulation during hemodialysis is associated with type of 
      vascular access and bedside coagulation testing: Results of a cross-sectional 
      study.
PG  - 1009748
LID - 10.3389/fmed.2022.1009748 [doi]
LID - 1009748
AB  - BACKGROUND: Recommendations and practice patterns for heparin dosing during 
      hemodialysis show substantial heterogeneity and are scantly supported by 
      evidence. This study assessed the variability in unfractionated heparin (UFH) 
      dosing during hemodialysis and its clinical and biological anticoagulatory 
      effects, and identified explanatory factors of heparin dosing. METHODS: 
      Cross-sectional study assessing UFH dosing, coagulation tests - activated partial 
      thromboplastin time (aPTT) and activated clotting time (ACT) before dialysis 
      start, 1 h after start and at treatment end (4 h) - and measurement of residual 
      blood compartment volume of used dialyzers. RESULTS: 101 patients, 58% male, with 
      a median dialysis vintage of 33 (6-71) months received hemodialysis using a total 
      UFH dose of 9,306 +/- 4,079 (range 3,000-23,050) IU/session. Use of a dialysis 
      catheter (n = 56, 55%) was associated with a 1.4 times higher UFH dose (p < 
      0.001) irrespective of prior access function. aPTT increased significantly more 
      than ACT both 1 h and 4 h after dialysis start, independent of the dialysis 
      access used. 53% of patients with catheter access and ACT ratio < 1.5, 1 h after 
      dialysis start had simultaneous aPTT ratios > 2.5. Similar findings were present 
      at 1 h for patients with AVF/AVG and at dialysis end for catheter use. No 
      clinically significant clotting of the extracorporeal circuit was noted during 
      the studied sessions. Dialyzer's blood compartment volume was reduced with a 
      median of 9% (6-20%) without significant effect of UFH dose, aPTT or ACT 
      measurements and vascular access type. CONCLUSION: UFH dose adaptations based on 
      ACT measurements frequently result in excessive anticoagulation according to aPTT 
      results. Higher doses of UFH are used in patients with hemodialysis catheters 
      without evidence that this reduces dialyzer clotting.
CI  - Copyright (c) 2022 De Troyer, Wissing, De Clerck, Cambier, Robberechts, Tonnelier 
      and Francois.
FAU - De Troyer, Marijke
AU  - De Troyer M
AD  - Division of Nephrology and Hypertension, Universitair Ziekenhuis Brussel (UZ 
      Brussel), Vrije Universiteit Brussel (VUB), Brussels, Belgium.
FAU - Wissing, Karl Martin
AU  - Wissing KM
AD  - Division of Nephrology and Hypertension, Universitair Ziekenhuis Brussel (UZ 
      Brussel), Vrije Universiteit Brussel (VUB), Brussels, Belgium.
FAU - De Clerck, Dieter
AU  - De Clerck D
AD  - Division of Nephrology and Hypertension, Universitair Ziekenhuis Brussel (UZ 
      Brussel), Vrije Universiteit Brussel (VUB), Brussels, Belgium.
FAU - Cambier, Marie-Laure
AU  - Cambier ML
AD  - Division of Nephrology and Hypertension, Universitair Ziekenhuis Brussel (UZ 
      Brussel), Vrije Universiteit Brussel (VUB), Brussels, Belgium.
FAU - Robberechts, Tom
AU  - Robberechts T
AD  - Division of Nephrology and Hypertension, Universitair Ziekenhuis Brussel (UZ 
      Brussel), Vrije Universiteit Brussel (VUB), Brussels, Belgium.
FAU - Tonnelier, Annelies
AU  - Tonnelier A
AD  - Division of Nephrology and Hypertension, Universitair Ziekenhuis Brussel (UZ 
      Brussel), Vrije Universiteit Brussel (VUB), Brussels, Belgium.
FAU - Francois, Karlien
AU  - Francois K
AD  - Division of Nephrology and Hypertension, Universitair Ziekenhuis Brussel (UZ 
      Brussel), Vrije Universiteit Brussel (VUB), Brussels, Belgium.
LA  - eng
PT  - Journal Article
DEP - 20221214
PL  - Switzerland
TA  - Front Med (Lausanne)
JT  - Frontiers in medicine
JID - 101648047
PMC - PMC9794613
OTO - NOTNLM
OT  - activated clotting time
OT  - activated partial thromboplastin time
OT  - anticoagulation
OT  - bleeding risk
OT  - dialyzer
OT  - extracorporeal circuit clotting
OT  - hemodialysis
OT  - heparin
COIS- The authors declare that the research was conducted in the absence of any 
      commercial or financial relationships that could be construed as a potential 
      conflict of interest.
EDAT- 2023/01/03 06:00
MHDA- 2023/01/03 06:01
PMCR- 2022/12/14
CRDT- 2023/01/02 04:40
PHST- 2022/08/02 00:00 [received]
PHST- 2022/11/28 00:00 [accepted]
PHST- 2023/01/02 04:40 [entrez]
PHST- 2023/01/03 06:00 [pubmed]
PHST- 2023/01/03 06:01 [medline]
PHST- 2022/12/14 00:00 [pmc-release]
AID - 10.3389/fmed.2022.1009748 [doi]
PST - epublish
SO  - Front Med (Lausanne). 2022 Dec 14;9:1009748. doi: 10.3389/fmed.2022.1009748. 
      eCollection 2022.