The Problem of Unintended Anticoagulation in Hemodialyis Patients

A 64 years old woman received a dialysis session through a new perm-catheter that was inserted while awaiting the construction of a new arterio-venous (AV) fistula. The day after dialysis she was brought comatose to the emergency room. Large left sided cerebral hemorrhage was diagnosed by brain CT scan. Her coagulation screen was remarkable for a PTT value of 180 seconds and PT of 26 sec. Her complete blood count including platelet count was within normal. Empirical protamine sulfate corrected the coagulopathy.