Hemorrhage during high-risk hemodialysis using controlled heparinization.

The risk of worsening or commencement of bleeding in high-risk patients requiring hemodialysis has not been established. The present study of 300 dialyses in 51 patients with prospectively assessed increased risk for bleeding describes a method for limiting heparin administration by using the thrombin clotting time to assess heparin sensitivity before dialysis and to monitor heparin levels during dialysis. The procedure prevented clotting in the extracorporeal device and limited bleeding complications to 5% of cases overall. Patients with a higher risk for hemorrhage had a higher incidence of bleeding complication (26%), a larger fall in hematocrit, and more frequent requirement for blood replacement. We conclude that although hemodialysis poses a risk for actively bleeding patients, patients at risk but without active bleeding can be dialyzed with strict control of heparin administration.