Alternative methods of anticoagulation for dialysis-dependent patients with heparin-induced thrombocytopenia.
Dialysis patients who are continually exposed to heparin are at risk for heparin-induced thrombocytopenia (HIT). Heparin-induced antibodies have been reported to occur in 0-12% of hemodialysis (HD) patients. The diagnosis or suspicion of HIT in this patient population requires careful confirmation of the diagnosis and substitution of heparin with an alternate anticoagulant for dialysis. Alternate agents such as the direct thrombin inhibitors (hirudin and argatroban) are available, but careful dosing and monitoring of the anticoagulant effect are required. Despite careful dosing, hemorrhagic complications have occurred with these agents. Unfortunately there are limited options for treatment of hemorrhagic complications and no specific antidotes are available for the direct thrombin inhibitors. In this report the currently available alternatives to heparin for dialysis, including dosing and monitoring recommendations, are reviewed.
O'Shea
Susan I
SI
Divisions of Hematology and Nephrology, Department of Medicine, Duke University Medical Center, Durham, North Carolina 27710, USA. oshea005@mc.duke.edu
Ortel
Thomas L
TL
Kovalik
Eugene C
EC
D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects*; D001120:Arginine / Q000031:analogs & derivatives; D002986:Clinical Trials as Topic; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006493:Heparin / Q000008:administration & dosage / Q000009:adverse effects*; D006496:Heparinoids / Q000627:therapeutic use; D024764:Hirudin Therapy / Q000379:methods; D006629:Hirudins / Q000031:analogs & derivatives*; D006801:Humans; D010446:Peptide Fragments / Q000627:therapeutic use; D010875:Pipecolic Acids / Q000627:therapeutic use; D011994:Recombinant Proteins / Q000627:therapeutic use; D006435:Renal Dialysis / Q000379:methods; D013449:Sulfonamides; D013917:Thrombin / Q000037:antagonists & inhibitors*; D013921:Thrombocytopenia / Q000139:chemically induced*
D000925:Anticoagulants; D005343:Fibrinolytic Agents; D006496:Heparinoids; D006629:Hirudins; D010446:Peptide Fragments; D010875:Pipecolic Acids; D011994:Recombinant Proteins; D013449:Sulfonamides; D006493:Heparin; D001120:Arginine; D013917:Thrombin; C031942:argatroban; C074619:bivalirudin