Low‐Dose Heparin in Routine Hemodialysis Monitored by Activated Partial Thromboplastin Time

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Abstract
To evaluate the use of the activated partial thromboplastin time (APTT), as measured by the Coag-A-Mate semi-automatic unit, in lowering the dosage of heparin in stable chronic hemodialysis patients, 4 protocols for anticoagulation were utilized. Ten patients were dialyzed 5 times with each protocol. In protocol I, clotting time was performed baseline, 2 and 4 h and in protocol II, baseline and every 30 min, with heparin administered by bolus to keep the clotting time at 2-2 1/2 times normal. In protocols III and IV the APTT was performed every 30 min, with heparin given by bolus in protocol III and infusion in protocol IV, to keep the APTT 1 1/2-2 times normal. Protocol I required 6000 .+-. 543 U [units] of heparin with the dose decreasing significantly to 3694 .+-. 158 U in protocol II, 2634 .+-. 139 U in protocol III and 2013 .+-. 117 U in protocol IV (P < 0.05 - < 0.001). Three episodes of clotting occurred, 1 in protocol III and 2 in protocol IV. There was no bleeding, and clearances of urea, creatinine, phosphate and uric acid at 1 and 5 h were similar in all protocols. APTT, as measured by the Coag-A-Mate unit, provides a simple means of lowering heparin requirements in routine dialysis patients.

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