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First published on December 26, 2007
Clinical and Applied Thrombosis/Hemostasis 2007, doi:10.1177/1076029607309184
© 2007 SAGE Publications
Management of Uremic Patients With Heparin-Induced Thrombocytopenia Requiring Hemodialysis
Takefumi Matsuo, MD*
and
Keiko Wanaka, PhD
Hyogo Prefectural Awaji Hospital
* To whom correspondence should be addressed. E-mail: tak-matsuo{at}deluxe.ocn.ne.jp.
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Abstract |
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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.
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