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Attitude of physicians in saudi arabia towards heparin administration and monitoring in hemodialysis patients.

This study was designed to evaluate the attitudes of the physicians in Saudi Arabia towards the use and monitoring of heparinization in hemodialysis patients. A questionnaire was sent to 162 physicians who collectively looked after 7390 patients in the 144 active dialysis centers in Saudi Arabia. A total of 142 out of the 164 (87.6%) physicians answered the questionnaire. Physicians who used conventional heparin were the vast majority; 131 (92.3%), while only four (2.8%) used low molecular weight heparin and seven (4.9%) used either of the two types. The method used for routine heparinization was constant infusion by 96 (84.5%) respondents, repeated bolus doses by 40 (28.2%) and either method by six (4.2%). A protocol for the use of heparin was available for only 100 (70.4%) of the respondents. To monitor heparinization, whole blood partial thrompoplastin time was used by 81 (57%) respondents, although 106 (74.6%) respondents believed that this test was reliable, reproducible and proportional to the serum concentration of heparin. The activated clotting time was used by only 39 (17.6%) and not available to 47 (33.1%); 84 (59.2%) believed in its reliability and reproducibility, while 11 (7.7%) did not and 47 (33.1%) had no idea. The Lee White clotting time was used by only 25 (17.6%) of the respondents; 37 (26%) considered it reliable and reproducible. The use of the automated devices at the bedside to perform the clotting time tests in the dialysis unit was believed to facilitate the monitoring process effectively by 106 (74.6%) respondents, while 19 (13.4%) did not believe in them. Accordingly, 127 (89.4%) respondents would use the automated devices in case they were available to them. In conclusion, a protocol to guide the heparinization in dialysis in Saudi Arabia is lacking in many centers and there is a need to provide them with automated bedside devices that monitor the clotting time for better implementation of the protocols.