Ward RA
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. (Daugirdas)

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Basic hemodialysis : Heparinization/anticoagulation