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Table 2 Overview of possible anticoagulants for hemodialysis in patients with CES

From: Cholesterol embolization syndrome and intra-abdominal bleeding immediately after initiation of hemodialysis: a case report with literature review

Anticoagulant Heparin (unfractionated) Low-molecular weight heparin Nafamostat mesylate Argatroban Citrate
Molecular weight 5000–30,000 (average 15,000) 2000–8000 (average 5000) 540 527 192
Blood half-life 60–90 min 120–180 min 5–8 min 15–30 min 5 min
Mechanism of anticoagulation Anti-factor Xa
Anti-thrombin
Anti-factor Xa Inhibit serine protease Anti-thrombin Chelating Ca2+
Advantage Wide availability
Large experience
Low costs
Antagonist available
Lower bleeding risk than unfractionated heparin Reduced bleeding risk
High costs
Adapted to HIT Strict regional anticoagulation-reduced bleeding risk
Disadvantage Risk of bleeding
HIT
No adequate reports of its use in CES patients
HIT
Rarely used outside of Japan
No adequate reports of its use in CES patients
Risk of bleeding
No adequate reports of its use in CES patients
Rarely used in Japan
Metabolic complication (alkalosis, hypocalcemia)
No adequate reports of its use in CES patients
  1. HIT heparin-induced thrombocytopenia