Vitamin K Antagonists

For HIT patients requiring long-term anticoagulation, vitamin K antagonists (coumarins) are usually given. Although coumarins decrease hemostasis and thrombosis, fibrin formation within the extracorporeal circuit is not always sufficiently blocked. In these cases, additional low-dose intravenous anticoagulation with UFH is usually given for regular maintenance HD. However, in HIT patients requiring HD, alternative low-dose anticoagulation has not been formally studied. The need for additional intravenous anticoagulation depends on the increase of the international normalized ratio (INR), which should be checked regularly before HD. Priming of the extracorporeal circuit by addition of a compatible anticoagulant to the filling solution with subsequent washout before start of the respective HD session may be of value in diminishing the risk of "overanticoagulation."

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