Table 19. Overview of the advantages and disadvantages of different anticoagulants in AKI patients.

Anticoagulant	Advantage	Disadvantage	References
Heparin (unfractionated)	Wide availability	Narrow therapeutic index – risk of bleeding	580, 581
	Large experience	Unpredictable kinetics – monitoring required
	Short half-life	HIT
	Antagonist available	Heparin resistance
	Monitoring with routine tests (aPTT or ACT)
	Low costs
Low-molecular-weight heparin	More predictable kinetics – Weight-based dosing possible	Risk of accumulation in kidney failure	580, 582, 583, 584
	More reliable anticoagulant response – No monitoring required	Monitoring requires nonroutine test (anti–Factor Xa)
	Single predialysis dose may be sufficient in IHD	Different drugs not interchangeable
	Reduced risk of HIT	Incomplete reversal by protamine
		In most countries more expensive than unfractionated heparin
Citrate	Strict regional anticoagulation – reduced bleeding risk	Risk of accidental overdose with potentially fatal consequences	585
		Insufficient citrate metabolism in patients with reduced liver function and shock states resulting in accumulation with metabolic acidosis and hypocalcemia
		Other metabolic complication (acidosis, alkalosis, hypernatremia, hypocalcemia, hypercalcemia)
		Increased complexity
		Requires strict protocol

aPTT, activated partial thromboplastin time; ACT, activated clotting time; HIT, heparin-induced thrombocytopenia; IHD, intermittent hemodialysis