Dose adjustment of heparin in the hemodialysis after vascular intervention

In hemodialysis patients, hemodialysis is frequently performed just after coronary angiography during angioplasty. However, the dose of heparin used in the intervention varies widely, making it difficult to perform hemodialysis safely. Therefore, we developed guidelines for heparin dose after such an intervention based on measurement of ACT (Activated Coagulation Time). We measured ACT at the beginning of hemodialysis, and the dose of heparin was selected based on the ACT values. When ACT is more than 200 sec, heparin infusion is discontinued. When ACT ranges from 150 to 200 sec, the dose of heparin is half of that used during regular hemodialysis, and when ACT is less than 150 sec, the dose of heparin is the same as that in regular hemodialysis. In this paper, we investigated the effectiveness of these guidelines. The coagulation time of ACT were measured before, 2 hours after the start and at the end of hemodialysis in 50 patients undergoing regular hemodialysis and 50 patients undergoing post-intervention hemodialysis. Just before the start of hemodialysis, the ACT of post-intervention patients was markedly prolonged to 173.6±65.1 sec, compared to 103.6±14.2 sec in those undergoing regular HD. Two hours after the start of HD, ACT was 150.5±39.4 sec in post-intervention patients, and 127.5±22.8 sec in those undergoing regular HD. At the end of HD, ACT was 133.7±25.0 in post-intervention patients and 119.3±18.8 in those undergoing regular HD, which was not significantly different. Therefore, we concluded that heparin dose adjustment guidelines are satisfactory.