title: Alternatives to standard unfractionated heparin for pediatric hemodialysis treatments.
abstract: Despite advances in biomaterials and dialyzer design, thrombin generation occurs in the dialysis circuit because of platelet and leukocyte activation. As such, anticoagulation is required by the majority of children for successful dialysis to prevent clotting in the venous air detector and the capillary dialyzer, particularly for small children with slower blood flow rates. For many years unfractionated heparin has been the standard anticoagulant of choice, but is now being challenged by low-molecular-weight heparins (LMWHs) because they are simple to administer and reliable, particularly as the cost differential has been eroded. Alternative, nonheparin anticoagulants are more frequently available, but are often restricted to special circumstances: patients at high risk of hemorrhage; heparin allergy; or heparin-induced thrombocytopenia. These nonheparin alternatives are significantly more expensive than heparins, and may add a degree of complexity, such as citrate, which is a regional anticoagulant, although citrate-containing dialysate may permit short anticoagulant-free dialysis sessions. Systemic anticoagulants required for immune-mediated, heparin-induced thrombocytopenia are expensive and either have short half-lives, and therefore require continuous infusions, or prolonged half-lives, which, although allowing simple bolus administration, increases the risk of drug accumulation, over-dosage and hemorrhage.
authors.affiliation: UCL Centre for Nephrology, Royal Free Hospital, University College London Medical School, Rowland Hill Street, London, NW3 2PF, UK. andrewdavenport@nhs.net
authors.forename: Andrew
authors.initials: A
authors.lastname: Davenport
mesh_terms: D000367:Age Factors; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics / Q000592:standards / Q000627:therapeutic use*; D001777:Blood Coagulation / Q000187:drug effects*; D002648:Child; D002675:Child, Preschool; D020099:Coated Materials, Biocompatible; D004867:Equipment Design; D006470:Hemorrhage / Q000139:chemically induced; D006493:Heparin / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics / Q000592:standards / Q000627:therapeutic use*; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D006801:Humans; D007223:Infant; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D006435:Renal Dialysis / Q000009:adverse effects / Q000295:instrumentation / Q000592:standards; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D020099:Coated Materials, Biocompatible; D006495:Heparin, Low-Molecular-Weight; D006493:Heparin