Therapeutic implications of heparin-induced thrombocytopenia complicating acute hemodialysis

• Type: Article in International Scientific Journal
• Date: 2010

Authors

Roncon-Albuquerque R Jr (Author) FMUP; Beco, A (Author) Other; Ferreira, AL (Author) Other; Gomes Carvalho, C (Author) Other; Costa, A (Author) Other; João Frazão (Author) FMUP; Pestana M (Author) FMUP; von Hafe P (Author) FMUP

Journal

Title: Clinical Nephrology

Vol. 73 No. 4

Pages: 326-330

ISSN: 0301-0430

Publisher: Dustri-Verlag Dr. Karl Feistle

Indexing

ISI Web of Knowledge - 1 Citation

Scopus - 1 Citation

Other information

Authenticus ID: P-003-7PG

Abstract (EN): Although patients undergoing acute hemodialysis (HD) constitute a group at risk for heparin-induced thrombocytopenia (HIT), the optimal therapeutic strategy remains undefined. We describe a case of HIT complicated with right subclavian vein thrombosis in a patient with chronic renal insufficiency undergoing acute HD for oligoanuria and pulmonary edema. Circulating anti-heparin-PF4 complex antibodies were detected. Past medical history was relevant for an otherwise unexplained self-limited episode of thrombocytopenia following acute HD one year earlier after an anterior STEMI. All sources of heparin were discontinued and alternative anticoagulation was initiated with argatroban, a direct-thrombin inhibitor with hepatic clearance, followed by transition to warfarin. Prevention of tunneled HD catheter obstruction was accomplished with low-dose alteplase catheter locking solution. No bleeding occurred with argatroban anticoagulation. Platelet count recovered and no further thrombotic complications were observed. The present report illustrates the diagnostic and therapeutic challenges of HIT complicating acute HD.

Language: English

Type (Professor's evaluation): Scientific

No. of pages: 5