A case review: Anticoagulation in hemodialysis patients with heparin-induced thrombocytopenia

We describe a patient with acute renal failure who subsequently developed h eparin-induced thrombocytopenia (HIT) while on hemodialysis. Heparin was im mediately discontinued and alternative modes of anticoagulation were consid ered as further hemodialysis was indicated. With several options available, a review of the current literature was performed to aid in the selection o f the most appropriate method. We conclude that there is currently no ideal hemodialysis anticoagulation agent for a patient with HIT. Among the curre ntly available alternatives, no anticoagulation or regional citrate infusio n during hemodialysis appears to be the most reliable and safest option for these patients. Based upon its safety, reversibility, low cost and availab ility, a trial of warfarin also may be attempted for hemodialysis anticoagu lation. Both danapranoid and lepirudin have been used effectively in hemodi alysis patients with HIT, but have the disadvantage of prolonged half-lives in patients with renal failure and relatively high cost. Copyright (C) 200 1 S. Karger AG, Basel.