Integrative Biomedical Research
Integrative Biomedical Research (Journal of Angiotherapy) | Online ISSN 3068-6326
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Volume 7 Number 1 2023
REVIEWS (Open Access)
Optimizing Heparin Use in Hemodialysis: Nursing Strategies, Bleeding Risk Management, and Anticoagulation Outcomes—A Systematic Review
Mohammed Shahidul Karim 1*, Happy Akter 2
Journal of Angiotherapy 7 (1) 1-8 https://doi.org/10.25163/biomedical.7110864
Submitted: 24 March 2023 Revised: 24 March 2023 Accepted: 24 March 2023 Published: 24 March 2023
Abstract
Hemodialysis remains indispensable for patients with end-stage renal disease, yet the question of how best to anticoagulate the extracorporeal circuit continues to challenge clinicians and nurses alike. Too little anticoagulation may result in circuit clotting and inadequate dialysis, whereas excessive anticoagulation can expose vulnerable patients to potentially serious bleeding events. This systematic review examined current evidence regarding heparin use in hemodialysis, with a particular focus on nursing protocols, anticoagulation strategies, circuit patency, and bleeding management. A structured literature search identified studies evaluating conventional unfractionated heparin (UFH), low-dose UFH, low-molecular-weight heparins (LMWHs), regional anticoagulation techniques, heparin-free dialysis approaches, and heparin-grafted membranes. Quantitative evidence from clinical studies was synthesized to compare clotting and bleeding outcomes across diverse patient populations. The findings revealed considerable variability in anticoagulation performance. Pharmacological approaches, particularly low-dose UFH and LMWH regimens, consistently demonstrated lower extracorporeal circuit clotting rates, with incidences as low as 0.13–1.1%. In contrast, heparin-free strategies generally reduced bleeding exposure but showed greater variability in circuit patency. Importantly, no single protocol emerged as universally superior. Rather, successful outcomes appeared closely linked to patient-specific risk assessment, nursing vigilance, and protocol adaptation. Overall, the evidence suggests that individualized anticoagulation management, supported by structured nursing surveillance and evidence-based decision-making, offers the most effective pathway for balancing dialysis efficiency with patient safety. Future multicenter studies are needed to establish standardized yet flexible approaches for diverse clinical settings. Keywords: Hemodialysis; Unfractionated Heparin; Anticoagulation Management; Dialysis Nursing; Bleeding Complications; Circuit Clotting; Patient Safety
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