Anticoagulants and extracorporeal circuits

Anticoagulants are pivotal to achieve circulation in extracorporeal circuits. In this review we discuss several anticoagulants in clinical use or in the preclinical phase. In hemodialysis the low-molecular-weight heparins (LMWHs) appear to be as effective and safe as standard heparin (SH). The main advantages of LMWHs in hemodialysis are the efficacy of a single loading dose, and the lack of laboratory control requirements. Newer anticoagulants such as dermatan sulfate and hirudin have been used in dose-finding studies in hemodialysis, although long-term experience is lacking. LMW heparinoid may be used to replace SH or LMWH in the case of heparin-induced thrombocytopenia. In cardiopulmonary bypass surgery (CPB) heparin-coated extracorporeal circuits are now being commonly applied. Their main advantage is the requirement of lower systemic dosages of heparin. In CPB the place of LMWH or other anticoagulants needs to be investigated.