Practical protocols for post‒procedural anticoagulant modification in patients undergoing hemodialysis

Abstract

Owing to expansion of the aging population, increasing numbers of patients are undergoing hemodialysis as well as surgeries and procedures to treat various complications. We investigated the application of protocols for modification of anticoagulants after such treatments. The study included 229 patients who received surgery in the Departments of Surgery, Ophthalmology, and Urology and also those who underwent endoscopic mucosal resection in the Department of Gastroenterology. On admission, anticoagulants used included unfractionated heparin (UFH, 80.0％), low‒molecular‒weight heparin (LMWH, 19.1％), and nafamostat (NM, 0.9％). The anticoagulants were administered as follows: UFH, 921.9±315.6 units (initial dose) and 691. 9±203.9 units/hour (maintenance dose); LMWH, 703.5±246.3 units (initial dose) and 542.4±210.8 units/hour (maintenance dose); NM 25.0±7.1 mg/hour (maintenance dose). Of 229 patients, 93.0％ were eligible for the protocols and 88.7％ received modified treatment based on them. The dose of each anticoagulant used did not significantly differ from that applied preoperatively. Our protocols were developed and implemented by a team comprising physicians, nurses, and clinical engineers involved in dialysis therapy, as well as a team of physicians and nurses from the department performing the invasive procedure. Perioperative management of patients who undergo hemodialysis requires interdepartmental and interprofessional collaboration, and protocols for anticoagulation modification in patients who undergo hemodialysis are important tools to facilitate team medicine.