Should heparin still be administered to a patient on warfarin, for Hemodialysis.?

Question

This patient had MV replacement. Heparin is administered routinely to all patients on HD. Also.. is there any special dialysate that should be used for such patients

Answer 1

Heparin and warfarin act as anticoagulants in different ways. Warfarin interferes with the biological utilization of vitamin K and thus interferes with the vitamin K dependent steps of the clotting cascade. It takes longer to exert its effects and can be trickier to control but once stable it can be used quite safely for long term anticoagulation for conditions such as phlebitis or atrial fibrillation. Heparin acts much more quickly and can be used to decrease clotting efficiency in an acute setting. If need be, its effects can also be reversed relatively quickly by the administration of protamine.