✅ Anticoagulation in Hemodialysis – MCQ Set 1 (Questions 1–10)
1. What is the most commonly used anticoagulant in routine hemodialysis?
A. Warfarin
B. Heparin
C. Citrate
D. Aspirin
✅ Correct answer: B
2. The primary purpose of anticoagulation during hemodialysis is to:
A. Prevent anemia
B. Prevent clotting in the dialyzer and extracorporeal circuit
C. Increase blood pressure
D. Reduce infection risk
✅ Correct answer: B
3. What is the usual route of heparin administration in hemodialysis?
A. Intramuscular
B. Oral
C. Intravenous
D. Subcutaneous
✅ Correct answer: C
4. What is a common complication of excessive heparin use during dialysis?
A. Hypertension
B. Bleeding
C. Hyperkalemia
D. Itching
✅ Correct answer: B
5. Which test is commonly used to monitor the effect of heparin?
A. Serum creatinine
B. PT/INR
C. Activated partial thromboplastin time (aPTT)
D. Fibrinogen
✅ Correct answer: C
6. In patients at high risk of bleeding, what anticoagulation approach is often used?
A. Full-dose heparin
B. No anticoagulation or saline flush protocol
C. Double dose heparin
D. Aspirin
✅ Correct answer: B
7. Which of the following is a low molecular weight heparin (LMWH) used in dialysis?
A. Enoxaparin
B. Warfarin
C. Aspirin
D. Sodium citrate
✅ Correct answer: A
8. Heparin-induced thrombocytopenia (HIT) is a:
A. Bleeding disorder
B. Hemolytic reaction
C. Prothrombotic condition with low platelets
D. Sign of dialysis failure
✅ Correct answer: C
9. What is the antidote for heparin overdose?
A. Vitamin K
B. Protamine sulfate
C. Fresh frozen plasma
D. Desmopressin
✅ Correct answer: B
10. What is the function of regional citrate anticoagulation in dialysis?
A. It removes calcium from blood to prevent clotting
B. It enhances potassium removal
C. It increases phosphorus clearance
D. It disinfects the blood circuit
✅ Correct answer: A
11. Which of the following patients is most likely to require a heparin-free dialysis?
A. Patient with diabetes
B. Patient with thrombocytosis
C. Post-operative patient with active bleeding
D. Patient on antihypertensive medications
✅ Correct answer: C
12. What is the mechanism of action of heparin?
A. Inhibits platelet aggregation
B. Chelates calcium
C. Activates antithrombin III to inhibit thrombin and factor Xa
D. Destroys clotting factors
✅ Correct answer: C
13. In low molecular weight heparin (LMWH) use, which test is best for monitoring?
A. aPTT
B. INR
C. Anti-factor Xa level
D. Hemoglobin
✅ Correct answer: C
**14. Which anticoagulant is preferred for patients with heparin-induced thrombocytopenia (HIT)?
A. Low dose heparin
B. Aspirin
C. Argatroban
D. Warfarin
✅ Correct answer: C
15. What is the risk of inadequate anticoagulation during dialysis?
A. Hypertension
B. Dialyzer clotting and circuit loss
C. Hypernatremia
D. Fluid overload
✅ Correct answer: B
16. What is a major concern when using regional citrate anticoagulation?
A. Hypokalemia
B. Hyperglycemia
C. Hypocalcemia
D. Hyponatremia
✅ Correct answer: C
17. When administering intermittent bolus heparin, the first dose is usually given:
A. At the end of dialysis
B. 30 minutes after dialysis begins
C. Before or at the start of dialysis
D. Only if clotting is seen
✅ Correct answer: C
18. During heparin-free dialysis, what technique is used to prevent clotting?
A. Use of aspirin
B. Pulse saline flushes every 15–30 minutes
C. High calcium dialysate
D. Blood flow reduction
✅ Correct answer: B
19. In which condition is systemic anticoagulation during dialysis generally contraindicated?
A. Stable angina
B. Recent hemorrhagic stroke
C. Hypertension
D. Diabetes mellitus
✅ Correct answer: B
20. Why might LMWH be preferred over unfractionated heparin in some dialysis centers?
A. Cheaper and more easily available
B. Longer half-life and easier dosing
C. More reversible with protamine
D. Eliminates risk of thrombosis
✅ Correct answer: B
21. What is the usual half-life of unfractionated heparin when used in dialysis?
A. 5 minutes
B. 30–60 minutes
C. 1–2 hours
D. 6–8 hours
✅ Correct answer: C
22. When using LMWH in dialysis, a common complication compared to UFH is:
A. More allergic reactions
B. Higher incidence of thrombocytopenia
C. Increased bleeding risk due to longer half-life
D. Lower cost
✅ Correct answer: C
23. Which of the following anticoagulation methods is most appropriate in a patient with severe liver failure on dialysis?
A. Warfarin
B. Unfractionated heparin
C. Citrate anticoagulation
D. LMWH
✅ Correct answer: C
24. What is the primary site of metabolism for low molecular weight heparin?
A. Liver
B. Kidney
C. Spleen
D. Bone marrow
✅ Correct answer: B
25. Which of the following is a contraindication to regional citrate anticoagulation?
A. Hypocalcemia
B. Sepsis
C. Hypertension
D. Diabetes
✅ Correct answer: A
26. Protamine sulfate reverses which of the following?
A. Warfarin
B. Citrate
C. Unfractionated heparin
D. Dabigatran
✅ Correct answer: C
27. Which anticoagulant does not require routine coagulation monitoring in stable patients?
A. Unfractionated heparin
B. LMWH
C. Warfarin
D. Argatroban
✅ Correct answer: B
28. What is the key reason for choosing heparin-free dialysis in a patient with recent gastrointestinal bleeding?
A. Improve blood pressure
B. Reduce sodium retention
C. Minimize bleeding risk
D. Increase urea clearance
✅ Correct answer: C
29. If clotting is observed in the venous chamber during dialysis, what should be done FIRST?
A. Start saline flushes
B. Increase heparin dose immediately
C. Stop dialysis immediately
D. Re-prime the dialyzer
✅ Correct answer: A
30. Warfarin is generally avoided in chronic hemodialysis patients because:
A. It causes hypokalemia
B. It requires monthly injections
C. It has high bleeding risk and is hard to control in ESRD
D. It reduces dialysis efficacy
✅ Correct answer: C
31. Which patient may need a reduced dose of heparin during dialysis?
A. Obese patient
B. Patient with active infection
C. Elderly patient with a history of GI bleeding
D. Diabetic with well-controlled sugars
✅ Correct answer: C
32. During dialysis, if the arterial pressure alarm is high and clotting is suspected in the line, what is the immediate action?
A. Increase blood flow rate
B. Flush with saline and assess for clot
C. Decrease dialysate flow
D. Ignore if patient is stable
✅ Correct answer: B
33. Which of the following anticoagulation methods is most commonly used in intermittent hemodialysis in outpatient centers?
A. Warfarin
B. LMWH
C. Heparin bolus followed by maintenance infusion
D. Argatroban
✅ Correct answer: C
34. Regional citrate anticoagulation works by binding to which electrolyte?
A. Magnesium
B. Potassium
C. Calcium
D. Phosphate
✅ Correct answer: C
35. When is saline flush protocol preferred over anticoagulation during dialysis?
A. In pediatric patients
B. In patients with severe anemia
C. In patients with high bleeding risk
D. In those on immunosuppressants
✅ Correct answer: C
36. What is a limitation of using LMWH in hemodialysis?
A. Requires frequent INR monitoring
B. Not reversible with protamine sulfate
C. Cannot be used in diabetic patients
D. Causes hypertension
✅ Correct answer: B
37. What is the main advantage of LMWH over UFH in hemodialysis?
A. Shorter half-life
B. Lower cost
C. Simplified dosing with fewer monitoring requirements
D. Safe in all liver diseases
✅ Correct answer: C
38. Which of the following is a sign of underdosing anticoagulation during dialysis?
A. Nosebleeds
B. Recurrent clotting in the circuit
C. Hypotension
D. Hematuria
✅ Correct answer: B
39. Which anticoagulant is sometimes used in patients with heparin allergy or HIT during dialysis?
A. Enoxaparin
B. Aspirin
C. Argatroban
D. Clopidogrel
✅ Correct answer: C
40. What lab finding is most concerning if a patient on heparin develops sudden thrombocytopenia?
A. Hemoglobin drop
B. Platelets <50,000 with thrombosis
C. Elevated creatinine
D. Prolonged PT
✅ Correct answer: B
41. Which of the following is a non-heparin anticoagulant suitable for dialysis in patients with HIT?
A. Fondaparinux
B. Argatroban
C. Warfarin
D. Tranexamic acid
✅ Correct answer: B
42. Why is warfarin generally not initiated solely for anticoagulation during hemodialysis?
A. It causes hyperkalemia
B. It increases calcium levels
C. It does not act quickly enough and is hard to manage in ESRD
D. It increases urea clearance
✅ Correct answer: C
43. A patient undergoing dialysis complains of sudden back pain and hypotension. What complication related to anticoagulation should you consider?
A. Hyperphosphatemia
B. Dialysis disequilibrium
C. Retroperitoneal bleed
D. Clotting in dialyzer
✅ Correct answer: C
44. What is the most accurate test to detect early HIT (Heparin-Induced Thrombocytopenia)?
A. PT
B. aPTT
C. Platelet factor 4 antibody (ELISA)
D. Bleeding time
✅ Correct answer: C
45. In hemodialysis, what is the target activated clotting time (ACT) during heparin use?
A. 60–90 seconds
B. 120–180 seconds
C. 180–220 seconds
D. >300 seconds
✅ Correct answer: B
46. What is a benefit of regional citrate anticoagulation over systemic heparin?
A. Easy to administer
B. Eliminates need for calcium monitoring
C. Less bleeding risk
D. Shorter dialysis time
✅ Correct answer: C
47. What is the function of calcium infusion during citrate anticoagulation?
A. Prevent clotting in the dialyzer
B. Maintain systemic calcium levels
C. Reduce potassium
D. Promote citrate clearance
✅ Correct answer: B
48. Which medication is not used for anticoagulation in dialysis patients?
A. Enoxaparin
B. Argatroban
C. Clopidogrel
D. Unfractionated heparin
✅ Correct answer: C
49. Heparin-induced thrombocytopenia typically occurs within how many days of starting heparin?
A. 1–2 days
B. 3–5 days
C. 5–10 days
D. 14–21 days
✅ Correct answer: C
50. Which of the following indicates the need for immediate discontinuation of anticoagulation during dialysis?
A. Mild bruising
B. Elevated creatinine
C. Sudden drop in blood pressure with active bleeding
D. Slight prolongation of aPTT
✅ Correct answer: C
