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Rinaldo Bellomo

and Ian Baldwin

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date: 20 June 2021

Continuous treatment suggests extracorporeal blood flow without clotting. This is not a realistic aim. However drugs blocking normal coagulation pathways can prevent or delay clotting such that sufficient treatment time is achieved, and importantly patient blood is returned before complete circuit obstruction. Anticoagulation primarily refers to the use of agents that prevent blood from clotting after contact with the plastic and artificial surfaces in the extracorporeal circuit (EC). Heparin is most commonly used as an anticoagulant for RRT by blocking factor Xa and thrombin. Citrate is also routinely used to prevent clotting by chelating calcium and preventing its action as a co-factor. Administration of anticoagulant drugs during RRT requires specific knowledge and the application of monitoring protocols to ensure safety and effectiveness. This chapter provides a brief clinical guide to such treatment.

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