Management of uremic patients with heparin-induced thrombocytopenia requiring hemodialysis.
Medical records of 122 patients with suspected heparin-induced thrombocytopenia on dialysis were reviewed. Method of dialysis in heparin-induced thrombocytopenia patients with bleeding from various causes (including surgical interventions) and how to cope with blood access occlusion induced by heparin-induced thrombocytopenia were studied. Of 122 patients, 17 who met the criteria of >30% thrombocytopenia, clots in the extracorporeal circulation, positive for heparin/PF4 complex antibodies, and improvement from heparin-induced thrombocytopenia with the use of an alternative anticoagulant or another strategy for heparin-induced thrombocytopenia were chosen. Argatroban was uneventfully introduced in 12 patients having neither bleeding nor blood access failure. In all, 2 of 5 patients were treated with peritoneal dialysis. The others requiring a regional anticoagulant were given nafamostat mesilate. Argatroban as an alternative provides effectively anticoagulation in patients with heparin-induced thrombocytopenia on dialysis. In patients with heparin-induced thrombocytopenia with bleeding and its associated risk, nafamostat mesilate was an alternative. Peritoneal dialysis also was applied in cases of blood access failure due to heparin-induced thrombocytopenia.
Matsuo
Takefumi
T
Hyogo Prefectural Awaji Hospital, 1-6-6 Simogamo, Sumoto, Japan. tak-matsuo@deluxe.ocn.ne.jp
Wanaka
Keiko
K
D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects*; D001120:Arginine / Q000031:analogs & derivatives; D001550:Benzamidines; D005260:Female; D006146:Guanidines / Q000627:therapeutic use; D006493:Heparin / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis; D010875:Pipecolic Acids / Q000627:therapeutic use; D013449:Sulfonamides; D013921:Thrombocytopenia / Q000139:chemically induced / Q000188:drug therapy*; D014511:Uremia / Q000628:therapy*
D000925:Anticoagulants; D001550:Benzamidines; D006146:Guanidines; D010875:Pipecolic Acids; D013449:Sulfonamides; D006493:Heparin; D001120:Arginine; C031942:argatroban; C032855:nafamostat