This study's objectives were to determine which anticoagulation
methods are commonly used in patients who are undergoing haemodialysis (HD) in
Spain, on what criteria do they depend, and the consequences arising from their
use. MATERIAL AND METHOD: Ours was a cross-sectional study based on two types of
surveys: a "HD Centre Survey" and a "Patient Survey". The first survey was
answered by 87 adult HD units serving a total of 6093 patients, as well as 2
paediatric units. Among these units, 48.3% were part of the public health system
and the remaining 51.7% units were part of the private health system. The patient
survey analysed 758 patients who were chosen at random from among the
aforementioned 78 HD units. RESULTs: A) HD Centre Survey: The majority of adult
HD units (n=61, 70.2%) used both kinds of heparin, 19 of them (21.8%) only used
LMWH and 7 of them (8%) only used UFH. The most frequently applied criteria for
the use of LMWH were medical indications (83.3% of HD units) and ease of
administration (29.5%). The most frequently used methods for adjusting the dosage
were clotting of the circuit (88.2% of units), bleeding of the vascular access
after disconnection (75.3%), and patient weight (57.6%). B) Patient Survey: The
distribution of the types of heparin used was: UFH: 44.1%, LMWH: 51.5%, and
dialysis without heparin in 4.4% of patients. LMWH was more frequently used in
public medical centres (64.2% of patients) than in private medical centres
(46.1%) (P<.001). LMWH was more frequently used in on-line haemodiafiltration
(HF) than in high-flux HD (P<.001). Antiplatelet agents were given to 45.5% of
patients, oral anticoagulants to 18.4% of patients, and both to 5% of patients.
Additionally, 4.4% of patients had suffered bleeding complications during the
previous week, and 1.9% of patients suffered thrombotic complications. Bleeding
complications were more frequent in patients with oral anticoagulants (P=.001),
although there was no association between the type of heparin and the occurrence
of bleeding or thrombotic complications. CONCLUSIONS: We are able to conclude
that there is a great amount of disparity in the criteria used for the medical
prescription of anticoagulation in HD. It is advisable that each HD unit revise
their own results as well as those from other centres, and possibly to create an
Anticoagulation Guide in Haemodialysis
