Haemodiafiltration 2 Anticoagula tion

• Anticoagulation of the circuit is usually with unfractionated heparin (200-2000IU/h), or a prostanoid (prostacyclin or PGE1) at 2-10ng/kg/min, or a combination of the two. Little experience is available on the use of low molecular weight heparin, citrate and other anticoagulants such as hirudin.

• No anticoagulant may be needed if the patient is auto-anticoagulated.

• Premature clotting may be due to mechanical kinking/obstruction of the circuit, insufficient anticoagulation, inadequate blood flow rates or to lack of endogenous anticoagulants (antithrombin III, heparin cofactor II).

• Usual filter lifespan should be at least 2 days but is often decreased in septic patients due to decreased endogenous anticoagulant levels. In this situation, consider use of fresh frozen plasma, a synthetic protease inhibitor such as aprotinin, or antithrombin III replacement (costly).

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