Center of Excellence in Translational Hematology, Division of Hematology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.
Namur Thrombosis and Hemostasis Center, Université Catholique de Louvain, Centre Hospitalier Universitaire UCL Namur, Hematology Laboratory, Yvoir, Belgium; Institut de Recherche Expérimentale et Clinique, Pôle Mont, Université Catholique de Louvain, Yvoir, Belgium.
Semin Nephrol. 2023 Nov;43(6):151477. doi: 10.1016/j.semnephrol.2023.151477. Epub 2024 Jan 30.
Unfractionated heparin (UFH) and low-molecular-weight heparins (LMWHs) are commonly used to prevent clotting of the hemodialysis extracorporeal circuit and optimize hemodialysis adequacy. There is no consensus on the optimal dosing for UFH and LMWHs during hemodialysis. In clinical practice, semiquantitative clotting scoring of the dialyzer and venous chamber may help to guide UFH and LMWH dose adjustment. Laboratory monitoring has not been shown to improve clinical outcomes and is therefore not routinely indicated in most hemodialysis patients. It might, however, be considered in select patients, such as those with extremes of body weight or history of repeated clotting or bleeding. Methods for laboratory monitoring include the activated partial thromboplastin time, activated clotting time, and antifactor Xa assays for UFH and antifactor Xa assay for LMWHs. Target ranges for anticoagulation in hemodialysis have been suggested but not clearly defined. When utilizing these tests, issues such as availability, standardization, interfering factors, and interpretation must be considered. In this narrative review, we discuss the rationale and methods of monitoring anticoagulation in hemodialysis.
未分级肝素（UFH）和低分子量肝素（LMWH）常用于防止血液透析体外回路的凝血和优化血液透析的充分性。UFH 和 LMWH 在血液透析期间的最佳剂量尚未达成共识。在临床实践中，对透析器和静脉腔的半定量凝血评分可能有助于指导 UFH 和 LMWH 剂量调整。实验室监测并未显示改善临床结局，因此在大多数血液透析患者中通常不推荐。然而，在某些特定患者中，如体重极端或有反复凝血或出血史的患者，可能需要考虑。实验室监测方法包括 UFH 的活化部分凝血活酶时间、活化凝血时间和抗因子 Xa 测定，以及 LMWH 的抗因子 Xa 测定。血液透析中抗凝的目标范围已被提出，但尚未明确界定。在使用这些检测时，必须考虑可用性、标准化、干扰因素和解释等问题。在本叙述性综述中，我们讨论了血液透析中抗凝监测的原理和方法。
