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NDT Advance Access originally published online on December 19, 2005
Nephrology Dialysis Transplantation 2006 21(6):1738; doi:10.1093/ndt/gfk015
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© The Author [2005]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Letter

Prevention of clot formation during haemodialysis using the direct thrombin inhibitor melagatran in patients with chronic uraemia

Email: per-ola.attman{at}vgregion.se

Sir,

We have read the editorial comment by MJ Flanigan [1] on our recent study ‘Prevention of clot formation during haemodialysis using the direct thrombin inhibitor melagatran in patients with chronic uraemia’.

We appreciate the comments, and agree with Dr Flanigan that the incriminate use of any anticoagulant also carries a risk for bleeding which can be serious. It is also true that the side-effects of post dialysis residual anticoagulant activity may not always be appreciated by patients or health care staff.

However, we feel that the statement >90% of routine haemodialysis can be achieved without anticoagulation does not reflect the current practice in the majority of dialysis centres. Although it is well established that haemodialysis treatment can be performed without anticoagulation in selected cases with increased risk for bleeding, this procedure is often laborious and is not generally practised. The almost universal use of anticoagulation in clinical practice should reflect the need for anticoagulation in routine haemodialysis.

Heparins are cheap but have potentially serious side-effects as reviewed in our paper. We therefore feel that the search for means to achieve both safe and predictable anticoagulation for haemodialysis must continue. We have explored the use of a new drug and a novel mode of administration and the future application of these principles must, of course be, evaluated from all aspects, including the risk for bleeding in farther studies.

Conflict of interest statement. None declared.

Per-Ola Attman

Department of Nephrology Sahlgrenska University Hospital Göteborg Sweden

References

  1. Flanigan MJ. Melagatran anticoagulation during haemodialysis – ‘Primum non nocere’. Nephrol Dial Transplant 2005; 20: 1789–1790[Free Full Text]

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This Article
Right arrow Extract Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow All Versions of this Article:
21/6/1738    most recent
gfk015v1
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