In the past, the bleeding time was considered
to be the most useful clinical test of coagulation
in patients with renal disease, but much of the
evidence supporting testing and treatment was
derived from poor-quality studies performed more
than 30 years ago. We now know that dialysis,
especially peritoneal dialysis, improves platelet
function. Erythropoietin, cryoprecipitate, conjugated
estrogens, desmopressin, and tranexamic
acid have all independently been shown to reduce
bleeding time.38,39 In the past decade, citrate has
risen in popularity as a replacement anticoagulant
in continuous renal-replacement therapy, with a
reduction in bleeding, although data on its safety
in patients with liver failure are lacking.40