Heparin: yes or no?

[Alex C.]

Since I've started dialysis, I've noticed that I bruise very easily, and often when I remove the band-aids the next day, they will still bleed a bit. I assume that Heparin is the cause of this. I've also heard that some people can dialyze without the benefits (and side-effects) of Heparin, instead by flushing every hour with saline. Since I am already at minimal fluid reduction and flush at least once each treatment with at least 100ml of saline (to reduce leg cramps), perhaps I can go completely without Heparin?

Does anybody else do this?

[Simon Dog]

I don't use any heparin with NxStage, and have minimal to no filter clots.    I was originally on 4000 heparin, then 2000, and eventually asked my doc if I could try no heparin and see how it worked for me.

When I am in center I flush 100ml every hour, also get good results.

I'm going nocturnal soon and have been advised the lower blood flow rate will necessitate heparin on a timed pump.

[Michael Murphy]

I had a massive hemorrhage in my left eye, doctor said it was not from heparin two weeks later another hemorrhage this time and ever since I would not allow any heparin.  My nephrologist and my eye doctor both told me to use the heparin when I asked why they said that if ii clot the machine I would loose the blood. Then I asked if I had a hemorrhage in my right eye wouldn't I be blind.  Loose a little blood or go blind, stop the damn heparin. In the last 3 months not clots but ever 30 minutes the clinic flushes my lines with 100 ml of saline.  More work for them but I refuse to risk my one working eye.  This week I am scheduled for surgery on my left eye.  Unless there is a change no heparin.

[PrimeTimer]

Recently, we ran my husband a little longer on his NxStage cycler. Did a little more than 4 hours instead of his usual 3 hrs 36 mins. I always give his lines a little saline flush during treatment but that time, by the time we did rinseback, his dialyzor filter didn't look so good. I performed rinseback but watched like a hawk. We won't be doing that again, at least not without first asking if/how much and when we should give him more Heparin and I wouldn't want to have to give him even more saline in his lines if he's needing fluid removed and when his BP is up. 

[kristina]

Since I've started dialysis, I've noticed that I bruise very easily, and often when I remove the band-aids the next day, they will still bleed a bit. I assume that Heparin is the cause of this. I've also heard that some people can dialyze without the benefits (and side-effects) of Heparin, instead by flushing every hour with saline. Since I am already at minimal fluid reduction and flush at least once each treatment with at least 100ml of saline (to reduce leg cramps), perhaps I can go completely without Heparin?

Does anybody else do this?

Hello Alex,
I have "only" had dialysis-treatment for about 6 months, but I also had my own problems with Heparin, i.e. hair-loss, diarrhea etc.
The doctors have changed "my" Heparin to Tinzaparin (sp?), but it is still a continuing learning process...
I do wish you good luck to find a suitable anticoagulant...
Good luck wishes from Kristina.

[Alex C.]

Well, so far I've gone 2 treatments without Heparin. What we do is, after figuring out my UF removal amount, I add 300ml to that, then instruct them to do extra 100 ml flushes at 1hr, 2hrs, and 3hrs. So far, everything is working fine, no problems.

[kristina]

Well, so far I've gone 2 treatments without Heparin. What we do is, after figuring out my UF removal amount, I add 300ml to that, then instruct them to do extra 100 ml flushes at 1hr, 2hrs, and 3hrs. So far, everything is working fine, no problems.

Hello Alex,
could you please elaborate on this further because I can't quite understand it ...
... and are there health-risks involved by not taking Heparin or anything else of that nature?
Thanks from Kristina. 

[Michael Murphy]

My nephroligist was not happy when I started refusing heparin and he told me it was not a good idea. When I asked why he said if I clotted I would loose the blood in the machine.  My next question was loose a little blood or go blind which seems a greater risk.  So I don't take heparin now.  In the 4 months I have been of heparin I clotted once.  I think that was because they forgot to flush the lines every half hour.  The only other down side is the flush puts 100 ml of saline into the patient so the tech needs to calculate that into the amount of fluid being removed.  My feeling is if heparin is not causing problems it's ok but if the problems are worse then the occasional blood loss then skip it.  However this will not make you popular with the dialysis tech,  when some one complained to me about the extra work I pointed out I wasn't going to risk going blind to make their job a little easier.  The only problem I now face is I had surgery on my left eye and it now works in about 6 weeks I am going to have to decide if I want to go back on heparin. As of now I think I will stay off of it.

[obsidianom]

Heparin has a very short half life of only 1.5 hour. That mans in a 3 hour dialysis session it is down to 1/4 of the start level and by 4.5 hours it is basically gone completely. That is why it generally is safe and causes few issues. Any bleeding that occurs later then about 5 hours is not from the heparin.
I find many dialysis nurses around here try to use less heparin in general and try to use the smallest dose possible.  My wife recently clotted at 2000 units after doing well at that dose for 3 years. I believe the reason was we are taking off more fluid now ( that is a LONG story), and the thicker blood clotted easier. We now use 3000 units.
Losing 1 circuit of blood is not a big deal as it is only about 200 ml on Nxstage.  however repeated losses are a different story.   
Try to find the lowest dose that works  . If you clot once the world wont end. 

[Alex C.]

For myself, the "lowest dose that works" seems to be zero. As long as that continues, I'll be happy.

BTW, my bleed times at removal seem to be much improved, and I haven't bruised as easily since.

[Michael Murphy]

My problem was two massive haemorrhages in my left eye both occurred just after dialysis started and left me with so much blood in my eye I was effectively blind.  I had to go to a specialist who put two shots in my eye over two months then I had to have surgery in the eye to remove the blood.  It turned out the procedure was minor and I can see out of the eye again. Depth perception is a wonderful thing to have.






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[LoneHighway]

This topic is old but I wanted to add that many centers have switched to the StreamLine system that NxStage puts out. It eliminates the “air gap” that was used in the drip chambers on both lines. No air equals much less clotting. The system is also cheaper, easier to set up, pretty much a win/win for everyone.

[GA_DAWG]

I have had only one bad experience from heparin. While they were transitioning from my catheter to the graft, I still had the catheter. After one treatment, my sites would not clot. After a couple hours, I was sent to the ER. There they did blood tests and found I had no clotting agent left, an OD of heparin had wiped it out. I was then given an IV of something to make it clot, but the nurse had to sit with me throughout the entire time because if a person is allergic, it can kill them pretty quickly is what I was told. After the IV, everything clotted fine, but instead of getting home from dialysis at 3:30 or $ like normal, it was closer to 1 am. The doctor who came to the ER was also the one who had put in the graft and was the lead transplant doctor. Once he realized the problem, he was highly unamused and called the clinic the next morning. To this day, they will not tell me what exactly he said, just that they do not want a repeat from him.

[Simon Dog]

I had to go to a specialist who put two shots in my eye over two months then I had to have surgery in the eye to remove the blood.  It turned out the procedure was minor

Oxymoron alert.  If somone is sticking needles in my eyeball and doing surgery I may use many manyt erms to describe it, but "minor" will not be one of them.

I had a tiny retinal bleed (which is in one of my medical charts as a rectal bleed ... so much for accuracy).  I subsequently tried dialysis (fistula) without heparin and found minimal clotting or less in the filter, and good clearances.   So, be sure you really need heparin - if I did not push back, I would still be taking it.

[Michael Murphy]

I stick by the term minor.  Prior to the procedure I was given enough  drugs to stun a elephant, during the extraction I had a wonderful time.  Watching the flow patterns as the bloody vitreous fluid was replaced with saline was most entertaining.  With out the drugs it probably would have been  a traumatic experience.