Abstract:
An adequate knowledge of anticoagulants used to prevent clotting in the extracorporeal circuit is crucial to provide optimal hemodialysis. Drugs can potentially prevent extracorporeal circuit clotting, but administration, half-life, and potential side effects differ. However, there is a lack of concise recommendations to guide anticoagulation and to avoid side effects. Because of the development of newer anticoagulant agents, direct thrombin inhibitors, and heparinoids, some of the side effects related to heparin may be overcome, but a deeper knowledge of these newer drugs is necessary. Moreover, types of heparin used, routes of administration, and health care economics vary around the world. We performed an extensive review of the literature, and the present article focuses on available anticoagulant drugs, exploring doses, side effects, particular use in hemodialysis, mechanism of action, pharmacokinetic properties, and use in special situations. Classical anticoagulants are still the standard of anticoagulation, but many questions remain unanswered; for example, is there real superiority of one treatment over another in terms of efficacy, safety, and health care economics? Anticoagulant protocols for hemodialysis need to be standardized and further studies performed to answer all of these questions.
摘要:
充分了解用于预防体外回路凝血的抗凝剂对于提供最佳血液透析至关重要。药物可以预防体外回路凝血,但是行政,半衰期,和潜在的副作用不同。然而,缺乏指导抗凝和避免副作用的简明建议。由于新型抗凝剂的开发,直接凝血酶抑制剂,和类肝素,可以克服与肝素有关的一些副作用,但对这些新药有更深入的了解是必要的。此外,使用的肝素类型,管理路线,医疗保健经济学在世界各地各不相同。我们对文献进行了广泛的回顾,本文重点介绍了现有的抗凝药物,探索剂量,副作用,特别用于血液透析,作用机制,药代动力学特性,并在特殊情况下使用。经典抗凝剂仍然是抗凝的标准,但是许多问题仍然没有答案;例如,在疗效方面,一种治疗方法是否比另一种治疗方法具有真正的优势,安全,和医疗保健经济学?血液透析的抗凝方案需要标准化,并进行进一步的研究以回答所有这些问题。