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Heparin-induced thrombocytopenia and dialysis

Joana Gameiro, Sofia Jorge, José António Lopes
Heparin-induced thrombocytopenia (HIT) is a serious and life-threatening complication that occurs in five per cent of patients exposed to heparin. It should be considered in patients with a platelet count <100×109 cells/l or a >50% decrease from baseline count in association with heparin therapy. Thromboembolic complications develop in 50% of patients. Bleeding is rare as the platelet count nadir typically does not drop below 20×109 cells/l. Up to 12% of dialysis patients develop HIT, named haemodialysis-related-heparin-induced thrombocytopenia (HD-HIT), as they are a risk group with continuous exposure to heparin...
June 2, 2018: Nefrología: Publicación Oficial de la Sociedad Española Nefrologia
Xiao Fu, Jian-Ping Ning
Anticoagulation therapy plays a vital role in the prevention of blood clot formation during hemodialysis and hemofiltration, especially for critical care patients. Here, we synthesized a novel argatroban (Arg)-modified polysulfone (PSf) membrane for anticoagulation. Arg was grafted onto the PSF membrane via chemical modification to increase membrane hydrophilicity. Protein adsorption, coagulation, as well as activation of platelets and complement systems were greatly reduced on the Arg-modified PSf membrane...
May 9, 2018: Journal of Materials Science. Materials in Medicine
Farzaneh Banki, Chandni Kaushik, David Roife, Kyle G Mitchell, Charles C Miller
The aim of this study was to assess symptomatic recurrence in patients who underwent a laparoscopic repair of large hiatal hernia without an esophageal lengthening procedure. Patients who underwent a laparoscopic repair of a large hiatal hernia from September 2009 to September 2015 by a single surgeon were identified in the retrospective review. The patients were followed up prospectively by the operating surgeon using a structured questionnaire, administered by telephone, to assess the symptoms. Symptomatic recurrence was defined as the requirement for a reoperative procedure for symptomatic recurrent hiatal hernia...
2017: Seminars in Thoracic and Cardiovascular Surgery
Jin Han Lim, Kyung Pyo Kang, Sik Lee, Sung Kwang Park, Won Kim
Heparin has remained the most commonly used anticoagulant for patients undergoing hemodialysis. It is usually safe to use but can have severe adverse effects in some cases. Heparin-induced thrombocytopenia (HIT) is a life-threatening complication of exposure to heparin. It results from an autoantibody directed against endogenous platelet factor 4 (PF4) in complex with heparin, which activates platelets and can cause catastrophic arterial and venous thromboses. Here, we present the case of an 80-year-old woman with a recent diagnosis of chronic renal failure who developed acute HIT (platelet count nadir, 15 × 109 /L) on day 7 of hemodialysis performed with routine heparin anticoagulation, who despite subsequent heparin-free hemodialysis (with argatroban and warfarin) developed recurrent HIT (complicated by acute cerebral infarction) on day 11 that we attributed to "rinsing" of the circuit with heparin-containing saline (3,000 units of unfractionated heparin, with subsequent saline washing) performed pre-dialysis as per routine...
April 2017: Hemodialysis International
Tomoko Fujii, Mari Akashi, Seita Morishita, Masanori Fukumoto, Hiroyuki Suzuki, Takatoshi Kobayashi, Teruyo Kida, Maki Kagitani, Ichiro Morino, Tsunehiko Ikeda
INTRODUCTION: In this study, we report a case of proliferative diabetic retinopathy in a patient with heparin-induced thrombocytopenia (HIT) in whom vitrectomy was performed with good results. CASE: A 57-year-old man presented with a chief complaint of decreased visual acuity (VA) in the left eye. Corrected VA of the left eye was 0.03, and ophthalmic examination showed fibrovascular membranes along the vascular arcade and a combined rhegmatogenous-traction retinal detachment with a macular hole...
January 2016: Case Reports in Ophthalmology
Asad John Torabi, Nikola Dobrilovic, Jai S Raman
BACKGROUND: Vena caval inflow occlusion, despite its utility in pediatrics, is rarely used in adults. We report the use of inflow occlusion in adults when cardiopulmonary bypass is contraindicated. METHODS: Between January 1999 and July 2014, 35 patients in 3 hospitals presented with right-sided cardiac lesions; 27 had right-sided endocarditis with sepsis despite maximal medical therapy, the rest had organized sterile masses with embolic potential in the right side of the heart...
September 2015: Asian Cardiovascular & Thoracic Annals
Heiko A Kaiser, Arbi Ben Abdallah, Nan Lin, Bethany R Tellor, Mohammad Helwani, Jennifer R Smith, Marc R Moon, Michael S Avidan
BACKGROUND: During 2007 and 2008 it is likely that millions of patients in the US received heparin contaminated (CH) with oversulfated chondroitin sulfate, which was associated with anaphylactoid reactions. We tested the hypothesis that CH was associated with serious morbidity, mortality, intensive care unit (ICU) stay and heparin-induced thrombocytopenia following adult cardiac surgery. METHODS AND FINDINGS: We conducted a single center, retrospective, propensity-matched cohort study during the period of CH and the equivalent time frame in the three preceding or the two following years...
2014: PloS One
Luis Quiñones-Ortiz, Ana Suárez-Laurés, Montserrat Pablos-de Pablo, Verónica Robles, Cristina Calzón-Blanco, Sara Quiñones-Pérez, Aitor Ayausty-Ruiz
We present the case of a patient diagnosed with likely immune heparin-induced thrombocytopenia (HIT II) based on clinical criteria and a positive ELISA test, in which emergency treatment was crucial, given the seriousness of the process. The discontinuation of heparin and administration of argatroban resolved inefficiency of dialysis resulting from repeated coagulation of the circuit and catheter, allowing peritoneal dialysis without further setbacks. We consider decision-making to be a priority before certifying diagnostic confidence...
2014: Nefrología: Publicación Oficial de la Sociedad Española Nefrologia
Pasquale Esposito, Carmelo Libetta, Ilaria Borettaz, Marisa Barone, Michele Canevari, Claudia Martinelli, Francesca Montagna, Salvatore Romeo, Elisa Margiotta, Marta Calatroni, Edoardo La Porta, Antonio Dal Canton
Heparin has remained the most commonly used anticoagulant in hemodialysis patients (HD). Its use is usually safe but, in some cases, important adverse effects can occur. Heparin-induced thrombocytopenia (HIT) is an immuno-mediated condition due to the formation of PF4/heparin/IgG complex leading to the activation of platelets and coagulative cascade. The consequent prothrombotic hypercoagulable state may cause venous or arterial thrombosis, skin gangrene and acute platelet activation syndrome. Clinical and laboratory findings may be suggestive for HIT, but formal diagnosis requires the demonstration of the presence of circulating antibodies...
May 2014: Giornale Italiano di Nefrologia: Organo Ufficiale Della Società Italiana di Nefrologia
Sian Robinson, Aleksander Zincuk, Ulla Lei Larsen, Claus Ekstrøm, Palle Toft
BACKGROUND: Previous pharmacokinetic trials suggested that 40 mg subcutaneous enoxaparin once daily provided inadequate thromboprophylaxis for intensive care unit patients. Critically ill patients with acute kidney injury are at increased risk of venous thromboembolism and yet are often excluded from these trials. We hypothesized that for critically ill patients with acute kidney injury receiving continuous renal replacement therapy, a dose of 1 mg/kg enoxaparin subcutaneously once daily would improve thromboprophylaxis without increasing the risk of bleeding...
June 13, 2014: Trials
L Joseph, A I Casanegra, M Dhariwal, M A Smith, M G Raju, M A Militello, M P Gomes, H L Gornik, J R Bartholomew
BACKGROUND: Heparin-induced thrombocytopenia (HIT) is an adverse immune-mediated response to unfractionated heparin and, less commonly, low molecular weight heparin. It is associated with a high thrombotic risk and the potential for limb and life-threatening complications. Argatroban is the only approved and currently available anticoagulant for HIT treatment in the USA. OBJECTIVES: To report safety and efficacy outcomes with bivalirudin for HIT treatment. METHODS: We retrospectively examined records from our registry of patients with a suspected, confirmed or previous history of HIT and who had received bivalirudin for anticoagulation in a single tertiary-care center over a 9-year period...
July 2014: Journal of Thrombosis and Haemostasis: JTH
Matthias Klingele, Hagen Bomberg, Anne Lerner-Gräber, Danilo Fliser, Aaron Poppleton, Hans J Schäfers, Heinrich V Groesdonk
OBJECTIVES: Acute kidney injury requiring renal replacement therapy (RRT) is a common complication after cardiac surgery, complicated by suspected or proven heparin-induced thrombocytopenia (type II). The present study evaluated the use of argatroban as an anticoagulant during continuous RRT in the early period after cardiac surgery. Argatroban was compared with unfractionated heparin (UH) with respect to bleeding complications and the effectiveness of anticoagulation. METHODS: Patients requiring RRT after cardiac surgery from March 2007 to June 2009 were identified...
June 2014: Journal of Thoracic and Cardiovascular Surgery
Takashi Nakamura, Kotaro Suemitsu, Junichi Nakamura
OBJECTIVE: The Japanese Society for Dialysis Therapy recommends superficialization of the brachial artery (BA) as an alternative vascular access (VA) technique in patients for whom a conventional internal shunt (arteriovenous fistula [AVF] or arteriovenous graft) cannot be created. Although 2% to 3% of Japanese hemodialysis patients undergo this procedure, it is not well recognized worldwide. We report here our experience with the procedure, as well as indications, durability, and morbidity...
May 2014: Journal of Vascular Surgery
Koon Ming Chan, Chi Yuen Cheung, Ka Foon Chau
Heparin-induced thrombocytopenia (HIT) is a potentially fatal clinical condition which can develop after exposure to unfractionated or low-molecular-weight heparins. Even small doses of heparin such as heparin flushes in hemodialysis catheter can induce the development of HIT. However, the true incidence of heparin lock-related HIT is unknown. We report a 58-year-old woman with acute kidney injury because of obstructive uropathy who developed HIT after heparin-free hemodialysis. She was found to have severe thrombocytopenia with deep vein thrombosis of left lower limb and arterial thrombosis of the right anterior and middle cerebral arteries...
April 2014: Hemodialysis International
Fang-fang Cao, Hai-tao Zhang, Xue Feng, Ruo-nan Jiao
OBJECTIVE: To assess the role of direct thrombin inhibitor argatroban in the renal replacement therapy. METHODS: Electronic databases including Cochrane library, PubMed, EMBASE, Highwire, MEDLINE, CBM, CNKI, and CSJD were searched using keywords including "Argatroban", "hemodialysis", "renal function", "renal failure", and "renal replacement therapy". A meta-analysis of all randomized controlled trials(RCTs)comparing argatroban with controls in renal replacement therapy was performed...
December 2013: Zhongguo Yi Xue Ke Xue Yuan Xue Bao. Acta Academiae Medicinae Sinicae
Andrew Davenport
Unfractionated heparin (UFH) is the most commonly used anticoagulant for hemodialysis worldwide. However, UFH comprises a series of different molecules with variable biological activity, thus risking under and over anticoagulation. As such, low molecular weight heparins (LMWHs) were developed to improve reliability. LMWHs are now established in clinical practice and have been proven to be effective in preventing extracorporeal circuit clotting, but also safer with fewer reported bleeding episodes and less heparin induced thrombocytopenia than UFH...
October 2013: Hemodialysis International
Ali Kordzadeh, Tomas Austin, Yiannis Panayiotopoulos
PURPOSE: The aim of this study is to examine the efficacy of normal saline (0.9% sodium chloride) as a flush solution on patency of arterial lines in comparison to heparin flush. Data have been examined in various categories of specialty (medical, surgical, cardiac, burns, gynecology), frequency of flushes, strength and volume of flushes, continuous versus bolus, duration of each flush and patency incidence (range, ≤ 24 to ≥ 96 hours). The secondary aim focused on the incidences of reported heparin-induced thrombocytopenia (HIT type I and II)...
March 2014: Journal of Vascular Access
Bruna Brunetta Gavranić, Nikolina Basić-Jukić, Petar Kes
Heparin-induced thrombocytopenia type II (HIT) is a clinicopathologic syndrome in which one or more clinical events are temporally related to heparin administration and caused by HIT antibodies. There are at least five different types of clinical events that are associated with HIT: thrombocytopenia; thrombosis; skin necrosis at heparin injection site, venous limb gangrene; and an acute systemic reaction that occurs 5-30 min after intravenous bolus of heparin. HIT typically presents 5-14 days after initiation of heparin therapy, later onset is unusual...
October 2012: Acta Medica Croatica: C̆asopis Hravatske Akademije Medicinskih Znanosti
Shinichiro Ikeda, Taro Hoshino, Taichi Nakamura
We report here a 79-year-old male having sarcoidosis without presentation of typical findings, such as respiratory symptoms, ocular signs, or skin lesions. Two weeks prior to admission to our hospital, he presented to a different hospital with acute renal failure, with blood urea nitrogen (BUN) and serum creatinine (Cr) levels of 67.9 mg/dl and 7.97 mg/dl, respectively, and was initiated on hemodialysis. The patient also exhibited fever, severe anorexia, and fatigue. We initially experienced difficulty in performing kidney biopsy due to a thrombocytopenia complication and severe general debility...
October 2014: Clinical Nephrology
Maria Francesca Notarangelo, Lucia Coppini, Federico Bontardelli, Francesca Boffetti, Luigi Vignali, Diego Ardissino
Bivalirudin is a direct thrombin inhibitor that has been approved for use in patients with or at risk for heparin-induced thrombocytopenia undergoing percutaneous coronary intervention. The efficacy of bivalirudin has been well documented in the setting of percutaneous coronary intervention, but there are only few data on its use in chronic dialysis-dependent patients. Bivalirudin is mainly eliminated enzymatically (80%) and to a lesser extent renally (20%). Nevertheless, in patients with chronic kidney disease a substantial increase in coagulation time and bleeding complications has been reported...
February 2013: Giornale Italiano di Cardiologia
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