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Dalteparin replacement of unfractionated heparin (UFH) for extracorporeal circuit (ECC) anticoagulation in an outpatient hemodialysis unit.

Anticoagulation is routinely required during hemodialysis to prevent clotting within the extracorporeal circuit (ECC). Although several methods of anticoagulation exist, unfractionated heparin (UFH) has, for many years, been the agent most commonly used in most hemodialysis units. The Institute of Safe Medical Practices (ISMP) has long identified UFH as a high-alert medication. Accordingly, Accreditation Canada's Required Organizational Practices 2017 have recommended limiting its availability to ensure that high-dose formats of heparin not be stocked in client service areas. As a result, our hemodialysis unit recently switched from UFH to the low molecular weight heparin (LMWH), dalteparin. Considered equally efficacious as UFH in ECC anticoagulation, pre-filled syringes of dalteparin were chosen because of greater product familiarity in dosing and administration within our regional renal program, superior device safety with retractable needle guards, and documented clinical experience in terms of safety and efficacy from other Ontario dialysis centres.

Dalteparin was administered at the beginning of dialysis for all patients currently receiving UFH. UFH was discontinued and a dose of 2,500 IU of dalteparin was substituted as a replacement. Dalteparin data will be tracked from March 2017 until Sept 2017 for these patients. Patients are evaluated for circuit/dialyzer clearing effectiveness, clotting/bleeding events, and final dose requirements to maintain the ECC.



Through our evaluation, we hope to show that dalteparin is a suitable alternative to UFH for ECC anticoagulation. With the data collected, we hope to observe similar benefits as documented by other Ontario dialysis centres using this medication.

Lesley Campbell, RN, CNeph(C), Lindsay, ON, Maryann Schneider, PharmD, RPh, BSP, ACPR, Lindsay, ON

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Author:Campbell, Lesley; Schneider, Maryann
Publication:CANNT Journal
Article Type:Brief article
Geographic Code:1CANA
Date:Apr 1, 2017
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