{"id":1232,"date":"2020-03-26T04:25:38","date_gmt":"2020-03-26T04:25:38","guid":{"rendered":"https:\/\/ami.advancedrenaleducation.com\/wparep\/?post_type=article&#038;p=1232"},"modified":"2025-05-09T15:59:50","modified_gmt":"2025-05-09T20:59:50","slug":"hemorrhage","status":"publish","type":"article","link":"https:\/\/ami.advancedrenaleducation.com\/wparep\/article\/hemorrhage\/","title":{"rendered":"Hemorrhage"},"content":{"rendered":"<h4>Risk Factors<\/h4>\n<ul>\n<li>Platelet dysfunction<\/li>\n<li>Ineffective platelet-vessel wall interaction and heparin induced thrombocytopenia (HIT)<\/li>\n<li>Use of anti-coagulation during HD<\/li>\n<li>Co-morbid conditions\n<ul>\n<li>Uncontrolled hypertension<\/li>\n<li>Liver disease, sepsis, certain medication (especially anti-platelet drugs )<\/li>\n<\/ul>\n<\/li>\n<li>Access site kept covered<\/li>\n<li>Venous needle falling out or catheter connection disrupted (venous pressure may fall too little to cause an alarm)<\/li>\n<\/ul>\n<h4>Risk Assessment<sup>1<\/sup><\/h4>\n<ul>\n<li>Very high &#8211; Active bleeding during HD<\/li>\n<li>High &#8211; Surgical\/traumatic wound within 3 days<\/li>\n<li>Low &#8211; Surgical\/traumatic wound &gt; 7 days<\/li>\n<\/ul>\n<h4>Diagnosis and Treatment<\/h4>\n<ul>\n<li>Screen for bleeding and activated clotting time<\/li>\n<li>Prolonged bleeding time &#8211; cryoprecipitate, DDAVP or conjugated estrogen acutely<\/li>\n<li>Prolonged PTT (heparin induced) &#8211; Protamine, FFP<\/li>\n<\/ul>\n<h4>Prevention<\/h4>\n<ul>\n<li>Should never keep access site covered<\/li>\n<li>Review heparin dose<\/li>\n<li>Strategy based on risk assessment<sup>1,2<\/sup><\/li>\n<li>Low risk &#8211; low dose conventional heparin, low molecular weight heparin<\/li>\n<li>Very high\/high risk &#8211; regional anticoagulation with heparin and protamine, heparin- free dialysis, regional citrate anticoagulation, Prostaglandin (PGI2), PD<\/li>\n<\/ul>\n<h4>Alternative Methods to Conventional Heparin for High-Risk Patients<\/h4>\n<table border=\"1\" cellspacing=\"5\" cellpadding=\"5\">\n<tbody>\n<tr>\n<td><strong>Methods<\/strong><\/td>\n<td><strong>Problems<\/strong><\/td>\n<\/tr>\n<tr>\n<td>Heparin-free dialysis<\/td>\n<td>Rebound<\/td>\n<\/tr>\n<tr>\n<td>Regional heparinization with protamine reversal<\/td>\n<td>anticoagulant, bleeding<\/td>\n<\/tr>\n<tr>\n<td>Low dose heparin<\/td>\n<td>Clotting of dialyzer<\/td>\n<\/tr>\n<tr>\n<td>Low molecular weight heparin<\/td>\n<td>Bleeding<\/td>\n<\/tr>\n<tr>\n<td>Prostacyclin<\/td>\n<td>Flushing and hypotension<\/td>\n<\/tr>\n<tr>\n<td>Regional citrate anticoagulation<\/td>\n<td>Complex technique, metabolic acidosis and hypocalcemia<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<div class=\"vcex-spacing\" style=\"height:30px\"><\/div><div class=\"vcex-module vcex-divider vcex-divider-solid\" style=\"width:100%;margin-top:20px;margin-bottom:20px;border-top-width:1px;border-color:#dddddd;\"><\/div>\n<h4>References:<\/h4>\n<ol>\n<li>Swartz RD, Port FK. Preventing hemorrhage in high-risk hemodialysis: Regional versus low-dose heparin. <em>Kidney Int<\/em> 16:513-518, 1979<\/li>\n<li>The EBPG Expert Group on Haemodialysis. Chronic intermittent haemodialysis and prevention of clotting in the extra corporal system. <em>Nephrol Dial Transplant<\/em> 17:S63-S71, 2002<\/li>\n<\/ol>\n<div class=\"vcex-spacing\" style=\"height:30px\"><\/div>\n","protected":false},"featured_media":0,"template":"","format":"standard","meta":{"_acf_changed":false},"categories":[5],"tags":[60],"language":[41],"articles":[268],"class_list":["post-1232","article","type-article","status-publish","format-standard","hentry","category-articles","tag-intradialytic","language-english","articles-hemodialysis","entry","no-media"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v26.5 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Hemorrhage - Advanced Renal Education Program<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/ami.advancedrenaleducation.com\/wparep\/article\/hemorrhage\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Hemorrhage - 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