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      A Case Review: Anticoagulation in Hemodialysis Patients with Heparin-Induced Thrombocytopenia

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          We describe a patient with acute renal failure who subsequently developed heparin-induced thrombocytopenia (HIT) while on hemodialysis. Heparin was immediately discontinued and alternative modes of anticoagulation were considered as further hemodialysis was indicated. With several options available, a review of the current literature was performed to aid in the selection of the most appropriate method. We conclude that there is currently no ideal hemodialysis anticoagulation agent for a patient with HIT. Among the currently available alternatives, no anticoagulation or regional citrate infusion during hemodialysis appears to be the most reliable and safest option for these patients. Based upon its safety, reversibility, low cost and availability, a trial of warfarin also may be attempted for hemodialysis anticoagulation. Both danapranoid and lepirudin have been used effectively in hemodialysis patients with HIT, but have the disadvantage of prolonged half-lives in patients with renal failure and relatively high cost.

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          Filling hemodialysis catheters in the interdialytic period: heparin versus citrate versus polygeline: a prospective randomized study.

          Heparin and saline are commonly used to fill hemodialysis central venous catheters to prevent their thrombosis during the interdialytic period. The purpose of this prospective clinical study was to evaluate whether replacing heparin with citrate or polygeline could ensure satisfactory catheter function without exposing patients to the risk of systemic heparinization. Thirty end-stage renal disease (ESRD) patients with subclavian or jugular single lumen catheters as temporary vascular access for hemodialysis were enrolled. After the insertion of the catheters, the patients were randomly assigned to one of the following three filling groups: Group A, heparin; Group B, citrate; Group C, polygeline. Before each dialysis, the filling solution was aspirated and clot volume, if present, was measured. The catheter usage time and the clot volume were 23 +/- 24 days and 0.052 +/- 0.035 ml in Group A, 51 +/- 36 days and 0.059 +/- 0.032 ml in Group B, and 32 +/- 10 days and 0.056 +/- 0.038 ml in Group C, respectively. Our results indicate that citrate or polygeline can replace heparin effectively as a filling solution for single lumen temporary hemodialysis catheters.

            Author and article information

            Am J Nephrol
            American Journal of Nephrology
            S. Karger AG
            June 2001
            25 June 2001
            : 21
            : 3
            : 226-231
            aDepartment of Medicine, and bDivision of Renal Diseases and Hypertension, University of Colorado Health Sciences Center, Denver, Colo., USA
            46252 Am J Nephrol 2001;21:226–231
            © 2001 S. Karger AG, Basel

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            Tables: 1, References: 31, Pages: 6
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