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      Safe and Effective Use of Chronic Transdermal Estradiol for Life-Threatening Uremic Bleeding in a Patient with Coronary Artery Disease

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          Abstract

          Uremic platelet dysfunction rarely causes significant bleeding in adequately dialyzed patients. When encountered, the management is complicated by a lack of well-supported treatment modalities. Estrogen use in uremic platelet dysfunction has been described, but enthusiasm for the treatment has been dampened by the risk of thrombotic events in vasculopathic dialysis patients. We present a patient on long-term peritoneal dialysis with coronary disease who developed recurrent life-threatening bleeding episodes secondary to uremia, where treatment with transdermal estrogen was used safely and effectively for a 24-month period.

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          Most cited references 11

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          Risk of venous thrombosis with oral versus transdermal estrogen therapy among postmenopausal women.

          Venous thromboembolism (VTE) is a main harmful effect of oral estrogen therapy among postmenopausal women. Transdermal estrogens may be safer but early results need to be confirmed. This review provides a summary of the most recent findings regarding the VTE risk among oral versus transdermal estrogens users.
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            Bleeding and thrombotic complications of kidney disease.

            With the rising prevalence of kidney disease, clinicians are increasingly faced with concerns about potential thrombotic and bleeding complications. Thrombotic risk, both arterial and venous, predominates with all severities of kidney disease but bleeding manifestations become an additional concern particularly with uraemia. This article reviews these contrasting problems and discusses strategies for prevention and management in the context of renal impairment, renal replacement therapy and renal transplantation.
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              Uremic bleeding: closing the circle after 30 years of controversies?

               M Noris,  G. Remuzzi (1999)
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                Author and article information

                Journal
                NNE
                NNE
                10.1159/issn.1664-5529
                Nephron Extra
                S. Karger AG
                1664-5529
                2014
                May – August 2014
                19 August 2014
                : 4
                : 2
                : 134-137
                Affiliations
                aDepartment of Internal Medicine, Rochester General Hospital, bNephrology Division, Department of Medicine, University of Rochester School of Medicine and Dentistry, and cDivision of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center, Rochester, N.Y., USA
                Author notes
                *John Kevin Hix, MD, Nephrology and Hypertension Unit, 370 Ridge Road East Suite L20, Rochester, NY 14621 (USA), E-Mail john.hix@rochestergeneral.org
                Article
                365480 PMC4164069 Nephron Extra 2014;4:134-137
                10.1159/000365480
                PMC4164069
                25337082
                © 2014 S. Karger AG, Basel

                Open Access License: This is an Open Access article licensed under the terms of the Creative Commons Attribution-NonCommercial 3.0 Unported license (CC BY-NC) ( http://www.karger.com/OA-license), applicable to the online version of the article only. Distribution permitted for non-commercial purposes only. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                Page count
                Tables: 1, Pages: 4
                Categories
                Case Report

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