If No Increased Risk of Bleeding
- Regional citrate rather than heparin as first line unless contraindicated
- If citrate contraindicated or as a second line alternative either unfractionated or low molecular weight heparin
If Increased Risk of Bleeding
- Regional citrate unless contraindicated
- Regional heparin should not be used
- All heparins should be stopped but anticoagulation should be continued during RRT as they are pro-thrombotic
- The direct thrombin inhibitor argobatran is recommended as first-line
- Other options include Factor Xa inhibitors such as danaparoid or fondaparinux