Sample interview questions: Can you explain your knowledge of the principles of anticoagulation and thrombosis prevention during dialysis?
Sample answer:
Principles of Anticoagulation during Dialysis
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Heparin: An unfractionated anticoagulant, heparin is commonly used during hemodialysis. It acts by binding to antithrombin III, enhancing its inhibitory effect on coagulation factors. Heparinization is initiated with a bolus dose and maintained with an infusion titrated to achieve an activated clotting time of 150-200 seconds.
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Low-molecular-weight heparins (LMWHs): LMWHs, such as enoxaparin or dalteparin, are fragmented forms of heparin with a lower molecular weight. They have a longer half-life and more predictable anticoagulant effect compared to heparin. LMWHs are administered subcutaneously or intravenously, with dosing adjusted based on patient weight and laboratory monitoring.
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Direct thrombin inhibitors (DTIs): DTIs, such as argatroban or bivalirudin, directly target and inhibit thrombin, the central enzyme in clot formation. They are used in patients with heparin-induced thrombocytopenia (HIT).
Principles of Thrombosis Prevention during Dialysis
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Fistula or graft maturation: Creating a stable fistula or graft access for hemodialysis is crucial. Preoperative planning and meticulous surgical technique minimize the risk of thrombosis.
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Antiplatelet agents: Antiplatelet agents, such as aspirin or clopidogrel, can inhibit platelet aggregation and reduce the risk of thrombosis in patients with vascular disease.
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