Treatment of hirudin overdosage in a dialysis patient with heparin-induced thrombocytopenia with mixed hemodialysis and hemofiltration treatment.
We report a patient who developed type II heparin-induced thrombocytopenia (HIT) and accidentally received a recombinant hirudin (r-hirudin) overdosage. Treatment with hemodialysis (HD) using high-flux polysulfone dialyzer and hemofiltration was performed. Length of treatment was adjusted, monitoring activated partial thromboplastin time (aPTT) to 1.5-2.5 times the mean of the normal range. She developed deep venous thrombosis and occlusion of vascular access. Only after cessation of heparin lock catheter, platelet count began to increase. After one year of treatment with acenocoumarol and additional low-dose r-hirudin, neither bleeding nor thrombotic episodes have been reported.
Mon
C
C
Nephrology Department, Hospital Severo Ochoa, Madrid, Spain. cmon.hsvo@salud.madrid.org
Moreno
G
G
Ortiz
M
M
Diaz
R
R
Herrero
J C
JC
Oliet
A
A
Rodriguez
I
I
Ortega
O
O
Gallar
P
P
Vigil
A
A
D000368:Aged; D062787:Drug Overdose / Q000628:therapy; D005260:Female; D006440:Hemofiltration / Q000379:methods*; D006493:Heparin / Q000009:adverse effects*; D024764:Hirudin Therapy / Q000009:adverse effects*; D006629:Hirudins / Q000506:poisoning*; D006801:Humans; D011994:Recombinant Proteins / Q000506:poisoning; D006435:Renal Dialysis / Q000379:methods*; D051437:Renal Insufficiency / Q000628:therapy; D013921:Thrombocytopenia / Q000139:chemically induced* / Q000628:therapy
D006629:Hirudins; D011994:Recombinant Proteins; D006493:Heparin; C083544:lepirudin