Safety and efficacy of heparin during dialysis in the context of systemic anticoagulant and antiplatelet medications

  • Steven M. Brunelli
  • Dena E. Cohen
  • Gilbert Marlowe
  • Daniel Liu
  • Levi Njord
  • David Van Wyck
  • George Aronoff
Original Article


Heparin is widely used to prevent coagulation during hemodialysis. Although systemic anticoagulants and antiplatelet agents are commonly prescribed in the hemodialysis population, the safety and efficacy of heparin in the presence of these medications is unclear. This retrospective cohort study considered adult hemodialysis patients treated in the United States (August 2015–July 2017). For each month, patients were ascribed a three-part exposure status (heparin use, anticoagulant use, antiplatelet agent use) based on electronic health records. Outcomes included anemia measures, peri-treatment bleeding and clotting, and hospitalization for gastrointestinal (GI) bleeding. Within systemic medication exposure categories, associations of heparin use were examined using adjusted generalized linear, negative binomial, or Poisson models. Across all systemic medication exposures, heparin use was associated with lower erythropoiesis stimulating agent (ESA) dose, higher hemoglobin levels, and lower monthly intravenous (IV) iron dose; lower rates of clotting during treatment and hospitalization for GI bleeding; and similar rates of peri-treatment bleeding. Associations with respect to ESA, IV iron, hemoglobin, and clotting were approximately twofold more potent in the absence of a systemic anticoagulant; the presence of an antiplatelet agent had little impact. Neither medication type influenced associations between heparin use and peri-treatment or GI bleeding. These results suggest that heparin use is safe and effective in the presence and absence of systemic anticoagulants and antiplatelet agents. Clinical judgment must be applied to assess bleeding risk in individual patients; however, the decision to withhold heparin should not solely be based upon the concurrent use of anticoagulant or antiplatet agents.


Hemodialysis Heparin Anticoagulation Bleeding 



This publication is the result of a research project conducted by the DaVita Institute for Patient Safety, Inc. a federally listed Patient Safety Organization, and is published with its permission. The data discussed herein has been certified as non-identifiable pursuant to 42 C.F.R. 3.212(a)(1). DaVita Clinical Research is a contractor to the DaVita Institute for Patient Safety, Inc.

Compliance with ethical standards

Conflict of interest

SMB’s spouse is an employee of AstraZeneca. All other authors have no disclosures.

Research involving human participants and/or animals

This article does not contain any studies with animals performed by any of the authors.

Informed consent

This was a retrospective study. For this type of study, formal consent is not required.

Supplementary material

40620_2018_576_MOESM1_ESM.docx (15 kb)
Supplementary material 1 (DOCX 15 KB)


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Copyright information

© Italian Society of Nephrology 2019

Authors and Affiliations

  • Steven M. Brunelli
    • 1
    • 2
  • Dena E. Cohen
    • 1
    • 2
  • Gilbert Marlowe
    • 1
    • 2
  • Daniel Liu
    • 2
  • Levi Njord
    • 2
  • David Van Wyck
    • 2
  • George Aronoff
    • 3
  1. 1.DaVita Clinical ResearchMinneapolisUSA
  2. 2.DaVita Institute for Patient Safety, IncDenverUSA
  3. 3.DaVita Kidney CareDenverUSA

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