A patient receives haemodialysis on Mondays and Thursdays. Which medication is administered as part of the dialysis procedure itself, and is therefore relevant to bleeding risk?

Correct answer: D. Heparin

• A. Clopidogrel likewise is a separate oral prescription, not a component of the dialysis circuit.
• B. Aspirin may be prescribed for cardiovascular protection but is not administered as part of dialysis.
• C. Warfarin is an oral anticoagulant taken by the patient at home for a separate indication such as atrial fibrillation. It is not part of the dialysis procedure.
• D. CORRECT. HEPARIN is infused during haemodialysis to prevent the blood from clotting within the extracorporeal circuit and dialyser. Its half-life is short — of the order of an hour or two — so the anticoagulant effect has largely resolved by the following day. This is the pharmacological reason dental treatment is scheduled on a NON-DIALYSIS day, ideally the day AFTER dialysis: the patient is heparin-free, metabolically corrected and less fatigued.

Note: Other dialysis considerations: avoid blood pressure readings and venepuncture in the ARM WITH THE AV FISTULA; avoid nephrotoxic drugs including NSAIDs; adjust doses of renally cleared agents; and expect anaemia, hypertension, altered bone metabolism from secondary hyperparathyroidism, and increased bleeding tendency from uraemic platelet dysfunction.