Abstract: Blood purification is an important treatment modality to clear toxins and other wastes from the body and to maintain electrolyte and acid-base balance, critical for patients’ survival and quality of life. However, blood quickly develops a coagulation reaction when it contacts filters and tubes, which lowers the adequacy of hemodialysis or even interrupts the hemodialysis. This reaction may also trigger the activation of coagulation system, leading to consumption of clotting factors, immune-inflammatory reactions, filter blockage, bleeding, thrombus formation, and other coagulation-related complications. With the advances of blood purification technology, the mechanisms of coagulation in the extracorporeal circulation and the effective anticoagulation strategies have been widely investigated. This review comprehensively summarizes the recent advances in the mechanisms of blood coagulation on equipment surfaces, and also briefly reviews the recent advances in inhibition of coagulation pathways, modification or engineering of membrane surfaces, and improvement of extracorporeal circuits.

Key words: Blood purification, Coagulation mechanism, Anticoagulation strategy