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