Management of Uremic Patients With Heparin-Induced Thrombocytopenia Requiring Hemodialysis

• Published in: Clinical and applied thrombosis/hemostasis Vol. 14; no. 4; pp. 459 - 464
• Main Authors: Matsuo, Takefumi, Wanaka, Keiko
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01.10.2008; SAGE PUBLICATIONS, INC
• Subjects: Aged; Aged, 80 and over; Alternatives; Anticoagulants; Anticoagulants - adverse effects; Female; Guanidines - therapeutic use; Hemodialysis; Heparin - adverse effects; Humans; Male; Middle Aged; Peritoneal Dialysis; Pipecolic Acids - therapeutic use; Thrombocytopenia - chemically induced; Thrombocytopenia - drug therapy; Uremia - therapy; peritoneal dialysis; nafamostat mesilate; argatroban; heparin-induced thrombocytopenia
• ISSN: 1076-0296; 1938-2723
• DOI: 10.1177/1076029607309184

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.