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Hemodialysis heparin

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https://www.readbyqxmd.com/read/27859427/citrate-buffered-dialysis-solution-citrasate-allows-avoidance-of-anticoagulation-during-intermittent-hemodiafiltration-at-the-cost-of-decreased-performance-and-systemic-biocompatibility
#1
Pavlina Richtrova, Jan Mares, Lukas Kielberger, Ladislav Trefil, Jaromir Eiselt, Tomas Reischig
Reportedly, citrate-based dialysis solution enables heparin dose tapering or even complete exclusion, particularly in postdilution hemodiafiltration (HDF). The aim of the study was to verify this strategy in predilution setting and to assess its short-term safety, efficacy, and biocompatibility. Ten regular hemodialysis patients were assigned to predilution HDF on acetate- and citrate-based dialysis solutions (0.8 mmol/l trisodium citrate) at random order. Acetate HDF was performed using routine dose of heparin while citrate HDF was heparin free...
November 10, 2016: Artificial Organs
https://www.readbyqxmd.com/read/27734602/recurrent-heparin-induced-thrombocytopenia-due-to-heparin-rinsing-before-priming-the-machine-in-a-hemodialysis-patient-a-case-report
#2
Jin Han Lim, Kyung Pyo Kang, Sik Lee, Sung Kwang Park, Won Kim
Heparin has remained the most commonly used anticoagulant for patients undergoing hemodialysis. It is usually safe to use but can have severe adverse effects in some cases. Heparin-induced thrombocytopenia (HIT) is a life-threatening complication of exposure to heparin. It results from an autoantibody directed against endogenous platelet factor 4 (PF4) in complex with heparin, which activates platelets and can cause catastrophic arterial and venous thromboses. Here, we present the case of an 80-year-old woman with a recent diagnosis of chronic renal failure who developed acute HIT (platelet count nadir, 15 × 10(9) /L) on day 7 of hemodialysis performed with routine heparin anticoagulation, who despite subsequent heparin-free hemodialysis (with argatroban and warfarin) developed recurrent HIT (complicated by acute cerebral infarction) on day 11 that we attributed to "rinsing" of the circuit with heparin-containing saline (3,000 units of unfractionated heparin, with subsequent saline washing) performed pre-dialysis as per routine...
October 13, 2016: Hemodialysis International
https://www.readbyqxmd.com/read/27670267/the-clock-trial-a-double-blinded-randomized-controlled-trial-trisodium-citrate-30-and-minocycline-3-mg-ml-plus-edta-30-mg-ml-are-effective-and-safe-for-catheter-patency-maintenance-among-ckd-5d-patients-on-hemodialysis
#3
Marcus V S João Luiz, Cristoforo Scavone, Carmen Tzanno
Introduction Poor blood flow rate (PF) is highly prevalent among CKD 5D patients with long-term central venous catheters. Heparin catheter lock solutions are commonly used to maintain catheter patency, however the incidence of PF remains high. The purpose of the CLOCK Trial was to evaluate two catheter lock solutions on reduction of PF incidence. Methods Seventy-five CKD 5D patients on high-efficiency hemodialysis at the Integrated Centre of Nephrology (Guarulhos, Brazil) were randomized 1:1:1 to receive a lock solution combining minocycline 3 mg/mL with the anticoagulant/chelation agent EDTA 30 mg/mL (M-EDTA) or heparin 1000 IU/mL (H) or trisodium citrate 30% (TSC) vs...
September 26, 2016: Hemodialysis International
https://www.readbyqxmd.com/read/27670146/three-cases-of-spontaneous-lumbar-artery-rupture-in-hemodialysis-patients
#4
Na Kyoung Hwang, Harin Rhee, Il Young Kim, Eun Young Seong, Dong Won Lee, Soo Bong Lee, Ihm Soo Kwak, Chang Won Kim, Sang Heon Song
We encountered three cases of retroperitoneal hematoma caused by spontaneous lumbar artery rupture, a rare vascular complication. At the time of retroperitoneal hematoma, two patients were on anticoagulant/antiplatelet therapy. One patient was not taking any anticoagulant/antiplatelet agents but was receiving hemodialysis treatment with heparin. Lumbar artery rupture was successfully controlled by transcatheter arterial embolization in all patients, but one patient developed multiple organ failure and died...
September 26, 2016: Hemodialysis International
https://www.readbyqxmd.com/read/27646929/pediatric-patients-undergoing-arteriovenous-fistula-surgery-without-intraoperative-heparin
#5
Susanne Regus, Veronika Almási-Sperling, Werner Lang
INTRODUCTION: Arteriovenous fistula (AVF) creation in children could be extremely challenging for vascular surgeons due to small vessels with a high tendency of vasospasm. This could be one reason for primary failures (PF) and early access thrombosis. There exists no guideline for the need of intraoperative heparin administration during hemodialysis fistula creation. The aim of this study was to evaluate the effect of intra-operative heparin administration on immediate outcome. METHODS: Medical records of 42 pediatric patients aged between 7 and 17 years were retrospectively reviewed...
September 20, 2016: Journal of Vascular Access
https://www.readbyqxmd.com/read/27609736/utilization-of-4t-score-to-determine-the-pretest-probability-of-heparin-induced-thrombocytopenia-in-a-community-hospital-in-upstate-new-york
#6
Yazan Samhouri, Mohammad Telfah, Ruth Kouides, Timothy Woodlock
BACKGROUND: Thrombocytopenia is common in hospitalized patients. Heparin-induced thrombocytopenia (HIT) is a life-threatening condition which can lead to extensive thrombosis. Diagnosis of HIT relies on clinical suspicion determined by 4T score and immunoassays through testing for anti-PF4/heparin antibodies. Clinical practice guidelines published by the American Society of Hematology in 2013 recommended use of the 4T score before ordering the immunoassays as a measure of pretest probability...
2016: Journal of Community Hospital Internal Medicine Perspectives
https://www.readbyqxmd.com/read/27576541/heparin-albumin-priming-in-a-clinical-setting-for-hemodialysis-patients-at-risk-for-bleeding
#7
Malin Skagerlind, Bernd Stegmayr
Introduction Intermittent hemodialysis (IHD) is sometimes necessary in patients with a bleeding risk, i.e., before/after surgery or brain hemorrhage. In such case IHD has to be modified to limit the conventional anticoagulation used to avoid clotting of the extracorporeal circuit (ECC). We evaluated if priming using a heparin and albumin (HA) mixture could minimize the exposure to heparin. Methods Retrospective data from 1995 to 2013 were collected from 1408 acute dialysis treatment protocols that included 321 patients...
August 31, 2016: Hemodialysis International
https://www.readbyqxmd.com/read/27573387/comparative-effectiveness-of-30%C3%A2-trisodium-citrate-and-heparin-lock-solution-in-preventing-infection-and-dysfunction-of-hemodialysis-catheters-a-randomized-controlled-trial-citrim-trial
#8
Franklin Correa Barcellos, Bruno Pereira Nunes, Luciana Jorge Valle, Thiago Lopes, Bianca Orlando, Cintia Scherer, Marcia Nunes, Gabriela Araújo Duarte, Maristela Böhlke
BACKGROUND: Central venous catheters (CVC) are the only option when hemodialysis is needed for patients without definitive vascular access. However, CVC is associated with complications, such as infection, thrombosis, and dysfunction, leading to higher mortality and expenditures. The aim of this study was to compare the effectiveness of 30 % trisodium citrate (TSC30 %) with heparin as CVC lock solutions in preventing catheter-related bloodstream infections (CRBSI) and dysfunction in hemodialysis patients...
August 29, 2016: Infection
https://www.readbyqxmd.com/read/27543785/a-comparison-of-red-blood-cell-transfusion-utilization-between-anti-activated-factor-x-and-activated-partial-thromboplastin-monitoring-in-patients-receiving-unfractionated-heparin
#9
K W Belk, M Laposata, C Craver
: Essentials Anti-activated factor X (Anti-Xa) monitoring is more precise than activated partial thromboplastin (aPTT). 20 804 hospitalized cardiovascular patients monitored with Anti-Xa or aPTT were analyzed. Adjusted transfusion rates were significantly lower for patients monitored with Anti-Xa. Adoption of Anti-Xa protocols could reduce transfusions among cardiovascular patients in the US. SUMMARY: Background Anticoagulant activated factor X protein (Anti-Xa) has been shown to be a more precise monitoring tool than activated partial thromboplastin time (aPTT) for patients receiving unfractionated heparin (UFH) anticoagulation therapy...
August 20, 2016: Journal of Thrombosis and Haemostasis: JTH
https://www.readbyqxmd.com/read/27516023/the-complexity-of-hemorrhage-generating-factors-in-various-organs-in-acute-kidney-injury
#10
Alexandru Rocşoreanu, Daniela Cernea, Cristiana Eugenia Simionescu, Eugen MoŢa
Bleeding disorders, associated with macroscopic and microscopic lesions in different organs are frequently found in acute kidney injury (AKI), in the third stage of the RIFLE (risk, injury, failure, loss, end-stage kidney disease) classification, treated by hemodialysis. The study included 81 cases of AKI of various causes (septic, posttraumatic, postoperative, toxic, medical nephropathies). 59.25% of the patients presented various forms of bleeding disorders (gastrointestinal bleeding, meningo-cerebral hemorrhage, epistaxis, hemodialysis vascular access bleeding, etc...
2016: Romanian Journal of Morphology and Embryology, Revue Roumaine de Morphologie et Embryologie
https://www.readbyqxmd.com/read/27477416/dialysis-induced-subdural-hematoma-in-an-arachnoid-cyst-associated-with-autosomal-dominant-polycystic-kidney-disease
#11
Tadayuki Takata, Yohei Kokudo, Kodai Kume, Kazuyo Ikeda, Masaki Kamada, Tetsuo Touge, Kazushi Deguchi, Tsutomu Masaki
Arachnoid cyst (AC) is a neurological complication of autosomal dominant polycystic kidney disease (ADPKD). Although an AC can increase the risk of a subdural hematoma, the clinical presentation of bleeding into an AC associated with ADPKD is not well known. We herein report the case of a 59-year-old woman in whom the initiation of hemodialysis for renal failure led to AC bleeding. A change of anticoagulant from heparin to nafamostat mesilate allowed dialysis to continue without rebleeding. These findings suggest that hemodialysis in patients with an AC associated with ADPKD may increase the risk of bleeding...
2016: Internal Medicine
https://www.readbyqxmd.com/read/27470252/the-risk-of-bleeding-with-tunneled-dialysis-catheter-placement
#12
Gerald A Beathard, Aris Urbanes, Terry Litchfield
PURPOSE: The purpose of this study was to evaluate the risk of bleeding associated with tunneled dialysis catheter (TDC) placement in a large population of hemodialysis patients who were either anticoagulated or were taking antithrombotic medications. METHODS: Medical records obtained over a two-year period were queried in order to select two groups of study cases. The first was a Med group (n = 458), cases which had a TDC placed while taking the antithrombotic medications (warfarin, clopidogrel or acetylsalicylic acid [ASA]) which were not discontinued or held...
September 21, 2016: Journal of Vascular Access
https://www.readbyqxmd.com/read/27427878/circuit-lifetime-with-citrate-versus-heparin-in-pediatric-continuous-venovenous-hemodialysis
#13
Tomáš Zaoral, Michal Hladík, Jana Zapletalová, Bořek Trávníček, Eliška Gelnarová
OBJECTIVES: To determine if there is a difference between regional citrate and global heparinized anticoagulation on circuit lifetimes during continuous venovenous hemodialysis in children. DESIGN: Prospective "cross-over" trial. SETTING: PICU, Department of Pediatrics, University Hospital Ostrava. PATIENTS: Children 0-18 years old. INTERVENTIONS: From 2009 to 2014, 63 eligible children (age, 89...
September 2016: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/27419685/-effectiveness-of-heparin-versus-0-9-saline-solution-in-maintaining-the-permeability-of-central-venous-catheters-a-systematic-review
#14
REVIEW
Eduardo José Ferreira Dos Santos, Maria Madalena Jesus Cunha Nunes, Daniela Filipa Batista Cardoso, João Luís Alves Apóstolo, Paulo Joaquim Pina Queirós, Manuel Alves Rodrigues
OBJECTIVE: Determining which is the most effective solution (heparin flush compared to 0.9% saline flush) for reducing the risk of occlusions in central venous catheters (CVC) in adults. METHOD: The systematic review followed the principles proposed by the Cochrane Handbook; critical analysis, extraction and synthesis of data were performed by two independent researchers; statistical analysis was performed using the RevMan program 5.2.8. RESULTS: Eight randomized controlled trials and one cohort study were included and the results of the meta-analysis showed no difference (RR=0...
December 2015: Revista da Escola de Enfermagem da U S P
https://www.readbyqxmd.com/read/27390716/is-taurolidine-citrate-an-effective-and-cost-effective-hemodialysis-catheter-lock-solution-a-systematic-review-and-cost-effectiveness-analysis
#15
Zahra Kavosi, Maryam Sarikhani Khorrami, Khosro Keshavarz, Abdosaleh Jafari, Amir Hashemi Meshkini, Hamid Reza Safaei, Shekoufeh Nikfar
BACKGROUND: Prevention of catheter-related infection is of prime importance,. However, because of the risks caused by the leakage of circulating antibiotics and development of resistance to antibiotics, they are replaced by lock solutions. The aim of this study was to evaluate the efficacy and cost- effectiveness of taurolidine-citrate as a hemodialysis catheter lock solution compared to other common alternatives in Iran. METHODS: To evaluate the efficacy of taurolidine-citrate, a systematic review was conducted by searching electronic databases...
2016: Medical Journal of the Islamic Republic of Iran
https://www.readbyqxmd.com/read/27344212/vitamin-e-coated-and-heparin-coated-dialyzer-membranes-for-heparin-free-hemodialysis-a-multicenter-randomized-crossover-trial
#16
Mohamed Shariful Islam, Zarih Alcheikh Hassan, Florence Chalmin, Sandor Vido, Mohamed Berrada, David Verhelst, Patrick Donnadieu, Olivier Moranne, Vincent L M Esnault
BACKGROUND: Hemodialysis requires effective anticoagulation to avoid blood circuit clotting. In patients at high risk for bleeding, several alternative methods have been developed. STUDY DESIGN: Multicenter, prospective, randomized, crossover study evaluating the noninferiority of vitamin E-coated compared with heparin-coated dialyzers in a 4-hour heparin-free hemodialysis strategy. SETTINGS & PARTICIPANTS: 32 adult long-term hemodialysis patients from 2 French hemodialysis units with well-functioning fistulas or double-lumen catheters...
June 23, 2016: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
https://www.readbyqxmd.com/read/27312907/is-regional-citrate-anticoagulation-the-future-of-hemodialysis
#17
Jadranka Buturovic-Ponikvar
Citrate has many characteristics of the ideal anticoagulant for hemodialysis. In addition to immediate and complete anticoagulation in the dialysis circuit, citrate has important effects beyond anticoagulation, mainly in reducing inflammatory response induced by hemodialysis. Citrate has already become the standard anticoagulant in acute kidney injury requiring continuous renal replacement therapy (CRRT), both for adults and children, with the citrate module being a part of modern CRRT monitors. Although the citrate module is not yet available for intermittent hemodialysis, precise infusion pumps, point-of-care ionometers and high citrate clearance from high flux dialyzers increase safety while reducing the risk of metabolic complications, both in adult and pediatric patients...
June 2016: Therapeutic Apheresis and Dialysis
https://www.readbyqxmd.com/read/27301545/post-operative-intracranial-hemorrhage-related-to-using-t-pa-for-declotting-an-occluded-hemodialysis-catheter-a-cautionary-tale
#18
Jillian Plonsker, Lee A Tan, Lorenzo F Munoz
Heparin and thrombolytic agents such as tissue plasminogen activator (t-PA) are frequently used to prevent and treat occluded hemodialysis (HD) catheters. Thrombolytic agents have not been well studied for systemic effects. We present a post-operative neurosurgical patient who experienced a symptomatic intracranial hemorrhage (ICH) after t-PA was used to treat an occluded HD catheter. This case highlights that using t-PA to treat dysfunctional catheters may be associated with ICH in neurosurgical patients. Management strategies are discussed with a review of pertinent literature...
October 2016: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
https://www.readbyqxmd.com/read/27191662/low-dose-versus-high-dose-heparin-locks-for-hemodialysis-catheters-a-systematic-review-and-meta-analysis
#19
Xin Han, Xiaoli Yang, Bihong Huang, Li Yuan, Yanpei Cao
BACKGROUND: Low-dose heparin lock has been suggested as an effective and safe catheter lock in hemodialysis. However, whether a low-dose lock is superior to a high-dose heparin lock in preventing catheter-related infections and maintaining catheter patency is inconclusive. STUDY DESIGN: A systematic review and meta-analysis was performed by searching in NGC (National Guideline Clearinghouse), Cochrane Library, Joanna Briggs Institute Library, MEDLINE, EMbase, RNAO (Registered Nurses' Association of Ontario), Nursing Consult, PubMed, OVID, China Biology Medicine disc (CBMdisc), China National Knowledge Infrastructure (CNKI), Chongqing VIP (CQVIP), Wanfang Data Knowledge Service Platform, and major nephrology journals...
July 2016: Clinical Nephrology
https://www.readbyqxmd.com/read/27189460/spontaneous-left-renal-subcapsular-hematoma-and-right-hip-hematoma-in-a-hemodialysis-patient-a-case-report-and-review-of-the-literature
#20
Muyao Ye, Yinghong Liu, Letian Zhou, Chang Wang, Xiao Fu, Youming Peng, Hong Liu
For maintenance hemodialysis (MHD) patients, the blood is in low hypercoagulable state due to the use of heparin or low molecular weight heparin during dialysis. It is not rare to see hematoma in the puncture site. In recent years, several cases have been reported of spontaneous kidney rupture, but no hip hematoma, let alone both occurred in succession. There was one MHD patient with spontaneous kidney bleeding and hip hematoma in our hospital in 2014, and we provided effective treatment and follow-up.
2016: Blood Purification
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