Hemodialysis and Argatroban

Matsuo, Takefumi; Wanaka, Keiko

doi:10.1055/s-0028-1086083

Cited by 2 publications

(2 citation statements)

References 27 publications

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“…The dose should also be reduced to <2μg/kg/min depending on the severity hepatic dysfunction to avoid unexpected hemorrhagic complications. Only the replacement of heparin with argatroban in dialysis can lead to recovery from symptoms of HIT (Gozdzikiewicz et al, 2007;Roncon-Albuquerque et al, 2010;Matsuo & Wanaka, 2008a). Despite there being no apparent evidence for the systemic administration of argatroban on non-session days, argatroban anticoagulation may be useful to prevent the risk of new and worsening thrombotic events.…”

Section: Management Of Hd-hit Patientsmentioning

confidence: 99%

Management of Heparin-Induced Thrombocytopenia in Uremic Patients with Hemodialysis

Matsuo¹

2012

Renal Failure - The Facts

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Section: Management Of Hd-hit Patientsmentioning

confidence: 99%

Management of Heparin-Induced Thrombocytopenia in Uremic Patients with Hemodialysis

Matsuo¹

2012

Renal Failure - The Facts

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“…The dose should also be reduced to <2μg/kg/min depending on the severity hepatic dysfunction to avoid unexpected hemorrhagic complications. Only the replacement of heparin with argatroban in dialysis can lead to recovery from symptoms of HIT [24][25][26]. Despite there being no apparent evidence to support the systemic administration of argatroban on non-session days, argatroban anticoagulation may prevent the risk of new and worsening thrombotic events.…”

Section: Clinical Manifestations and Laboratory Testing In Hd-hit Patmentioning

confidence: 99%

Heparin-Induced Thrombocytopenia and Hemodialysis

Matsuo¹

2013

J Blood Disord Transfus

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Hemodialysis-related-heparin-induced thrombocytopenia (HD-HIT) is a drug-induced, immunoglobulinmediated disorder that it is suspected in dialysis patients with an unexpected fall in the platelet count, and/or unexplained thrombotic events, particularly visible clotting in the circuit under an adequate heparin dose, that begins between 5 and 10 days (nadir between 7 and 30 days, mostly by the third to fifth session) after heparin initiation. Although a positive result for anti-PF4/heparin complex antibodies (HIT antibodies) is presumably detected by sensitive ELISA, the diagnosis should be confirmed, whenever possible, using a functional assay. Immediately after the clinical suspicion of HIT, all sources of heparin should be discontinued including heparin used to flush or lock catheters. Alternative non-heparin anticoagulants, preferentially a direct thrombin inhibitor, should be restarted for dialysis. Early treatment is important as thrombus formation including a clotting circuit may complicate at a high rate within 30 days after the cessation of heparin. Argatroban, a synthetic direct thrombin inhibitor, as an alternative to heparin, must contribute to the rapid recovery of the platelet count and disappearance of visible circuit clotting. A steady decreasing of the ELISA titers can be expected after heparin discontinuation. A negative seroconversion of HIT antibodies is usually observed by ~30 to more than 100 days after discontinuation. Re-exposure to heparin can be selected at the same dose of heparin as used before the onset of HIT. A small peak of HIT antibodies may often appear after exposure, but a follow-up of the antibody titers shows that they not reach a threshold to induce the recurrence of HIT. When HD-HIT patients exhibit a high index of thrombotic formation or worsening thrombosis, the same alternative anticoagulant therapy may be needed on non-session days.

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Hemodialysis and Argatroban

Cited by 2 publications

References 27 publications

Management of Heparin-Induced Thrombocytopenia in Uremic Patients with Hemodialysis

Management of Heparin-Induced Thrombocytopenia in Uremic Patients with Hemodialysis

Heparin-Induced Thrombocytopenia and Hemodialysis

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