Why do I need anticoagulants for hemodialysis? What are the common anticoagulants? Hemodialysis is actually a form of extracorporeal circulation and anticoagulants must be used to prevent blood from clotting during extracorporeal circulation as a guarantee for the smooth performance of hemodialysis. The commonly used anticoagulant is heparin, and the dosage of heparin varies greatly due to the individual differences of each patient. Insufficient dosage of heparin will result in coagulation, leading to loss of blood during dialysis; too much heparin will result in the risk of bleeding, for example, if the puncture needle eye is compressed for a long time and still fails to stop bleeding. It usually takes a period of time to figure out the appropriate and safer dosage of heparin. In the event of the following conditions, such as bleeding from the nose or gums, a fall or bump, coughing up blood, blood in the stool, or during menstruation, the patient needs to tell the healthcare provider before dialysis so that the heparin dosage can be reduced or heparin-free dialysis can be used appropriately to avoid aggravating the bleeding. However, clotting of the filter line may occur when reducing the dosage or using heparin-free dialysis. When is heparin-free dialysis performed? When a patient has active bleeding and is at high risk of bleeding, the use of anticoagulants for dialysis will exacerbate the risk of bleeding and dialysis can only be performed without anticoagulants altogether, i.e. heparin-free dialysis. The biggest obstacle to heparin-free dialysis is the tendency for extracorporeal coagulation to occur, making it difficult to ensure that dialysis proceeds smoothly. Therefore, patients and families should understand the possibility of coagulation. During dialysis, we will take certain measures to minimize the occurrence of clotting. Please do not be alarmed when blood clotting occurs; it has no effect on the patient’s own life safety, and some blood may be lost. Another risk that cannot be completely avoided with heparin-free therapy is the risk of clot dislodgement causing embolism of vital organs such as the brain and heart. Therefore, doctors cannot make the best of both worlds.