Heparinization for routine hemodialysis
Adv Renal Replacement Ther
(Oct) 2:362-370 1995
This paper describes Dr. Ward's approach to heparin kinetic modeling.
Heparin pharmacokinetics are defined
according to two variables: sensitivity and elimination half-life.
Sensitivity is determined by injecting a test dose of heparin and measuring
the prolongation of WBPTT or ACT. Elimination half life is determined by
starting heparin infusion after a loading dose and determining the rise or
fall in WPBPTT or ACT. Once these values are known, individualized heparin
dosing is possible to keep the WBPTT or ACT in the desired range. This is
200-250% of baseline for the WBPTT or 140-180% of the ACT according to Dr.
Ward. Using this method, he found that the initial loading dose varies from
1000-3000 IU and the infusion rate from 1000-3000 IU/hr.
Comment: The usefulness of heparin modeling has not been well
established, and with the advent of low molecular weight heparin, may soon
become obsolete. However, for the time being, heparin modeling may be a
useful approach and may increase the number of reuses, although the latter
has not been formally addressed in a controlled study.
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