 Anticoagulation is one of the supporting pillars of chronic hemodialysis HD 1. The optimal anticoagulant regimen provides full anticoagulation of the extracorporeal circuit with minimal systemic effects and comes at an affordable cost. Unfractionated heparin UFH has been the standard of care for many years. In several countries, UFH has gradually been replaced by low molecular weight heparins LMWH. LMWH are easy to use as they can be administered as a bolus injection and reduce membrane fibrin and platelet deposition 2,1. Both UFH or LMWH provide adequate anticoagulation of the extracorporeal circuit, at the price of systemic anticoagulation. Apart from bleeding, the administration of unfractionated heparins has also been associated with dyslipidemia, hypoaldosteronism and hyperkalemia, thrombopenia, osteoporosis, pruritus, and hypersensitivity reactions. 