Key result
Direct thrombin inhibitors offer viable anticoagulation in dialysis patients with HIT but require careful monitoring.
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Dialysis patients who are continually exposed to heparin are at risk for heparin-induced thrombocytopenia (HIT). Heparin-induced antibodies have been reported to occur in 0-12% of hemodialysis (HD) patients. The diagnosis or suspicion of HIT in this patient population requires careful confirmation of the diagnosis and substitution of heparin with an alternate anticoagulant for dialysis. Alternate agents such as the direct thrombin inhibitors (hirudin and argatroban) are available, but careful dosing and monitoring of the anticoagulant effect are required. Despite careful dosing, hemorrhagic complications have occurred with these agents. Unfortunately there are limited options for treatment of hemorrhagic complications and no specific antidotes are available for the direct thrombin inhibitors. In this report the currently available alternatives to heparin for dialysis, including dosing and monitoring recommendations, are reviewed.
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O’Shea et al. (2003) conducted a review in Heparin-induced thrombocytopenia (HIT) in dialysis-dependent patients. Alternative anticoagulants (direct thrombin inhibitors such as hirudin and argatroban) vs. Heparin was evaluated. Direct thrombin inhibitors such as hirudin and argatroban serve as alternative anticoagulants for dialysis patients with heparin-induced thrombocytopenia, requiring careful dosing and monitoring.
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