Heparin-associated antiplatelet antibodies increase morbidity and mortality in hemodialysis patients

Mureebe, Leila; Coats, Richard D.; Silliman, W.R.; Shuster, Thomas A.; Nichols, W. Kirt; Silver, Donald

doi:10.1016/j.surg.2004.07.004

Cited by 32 publications

(17 citation statements)

References 21 publications

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“…69,71 In one single-center study, vascular access thrombosis occurred in 40% of patients with HIT. 72 In contrast, in a national survey of HIT in the hemodialysis population in the United Kingdom, serious complications occurred less frequently: only 8% had a deep vein thrombosis, 4% experienced a pulmonary embolism, and 4% experienced a retroperitoneal hemorrhage. 68 Other rare complications include case reports of skin necrosis and pseudo-pulmonary embolism.…”

Section: Complications Of Ufh Usementioning

confidence: 91%

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Use and Safety of Unfractionated Heparin for Anticoagulation During Maintenance Hemodialysis

Shen

Winkelmayer

2012

American Journal of Kidney Diseases

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Anticoagulation is essential to hemodialysis, and unfractionated heparin (UFH) is the most commonly used anticoagulant in the United States. However, there is no universally accepted standard for its administration in long-term hemodialysis. Dosage schedules vary and include weight-based protocols and low-dose protocols for those at high risk of bleeding, as well as regional anticoagulation with heparin and heparin-coated dialyzers. Adjustments are based largely on clinical signs of under- and overanticoagulation. Risks of UFH use include bleeding, heparin-induced thrombocytopenia, hypertriglyceridemia, anaphylaxis, and possibly bone mineral disease, hyperkalemia, and catheter-associated sepsis. Alternative anticoagulants include low-molecular-weight heparin, direct thrombin inhibitors, heparinoids, and citrate. Anticoagulant-free hemodialysis and peritoneal dialysis also are potential substitutes. However, some of these alternative treatments are not as available as or are more costly than UFH, are dependent on country and health care system, and present dosing challenges. When properly monitored, UFH is a relatively safe and economical choice for anticoagulation in long-term hemodialysis for most patients.

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Section: Complications Of Ufh Usementioning

confidence: 91%

“…72,79-83 The prevalence of heparin-induced antibodies is as high as 17% in hemodialysis patients; therefore, this is a potentially major determinant of outcome in this population.…”

Section: Complications Of Ufh Usementioning

confidence: 99%

Use and Safety of Unfractionated Heparin for Anticoagulation During Maintenance Hemodialysis

Shen

Winkelmayer

2012

American Journal of Kidney Diseases

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“…Anti‐heparin‐platelet factor 4 (anti‐HPF4) antibodies were detected in 1.1%‐12% of patients receiving dialysis, and only a small portion of these patients experienced thrombocytopenia (0%‐3.8%) or thrombosis (0$‐3.8%) 80 . Some studies have suggested that the mere presence of anti‐HPF4 antibodies in HD patients receiving heparin is associated with increased morbidity and mortality 81,82 . However, this complex relationship is not yet thoroughly understood.…”

Section: Intermittent Extracorporeal Medical Devicesmentioning

confidence: 99%

Anticoagulation strategies in extracorporeal circulatory devices in adult populations

Kato

Oakes

Kim

et al. 2020

European J of Haematology

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Extracorporeal circulatory devices such as hemodialysis and extracorporeal membrane oxygenation can be lifesaving; however, they are also prone to pathologic events including device failure, venous and arterial thrombosis, hemorrhage, and an accelerated risk for atherosclerotic disease due to interactions between blood components and device surfaces of varying biocompatibility. While extracorporeal devices may be used acutely for limited periods of time (eg, extracorporeal membrane oxygenation, continuous venovenous hemofiltration, therapeutic apheresis), some patients require chronic use of these technologies (eg, intermittent hemodialysis and left ventricular assist devices). Given the substantial thrombotic risks associated with extracorporeal devices, multiple antiplatelet and anticoagulation strategies—including unfractionated heparin, low‐molecular‐weight heparin, citrate, direct thrombin inhibitors, and direct oral anticoagulants, have been used to mitigate the thrombotic milieu within the patient and device. In the following manuscript, we outline the current data on anticoagulation strategies for commonly used extracorporeal circulatory devices, highlighting the potential benefits and complications involved with each.

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“…[7][8][9] The presence of HIT antibodies in patients undergoing hemodialysis is presumed to be associated with higher rates of morbidity and mortality, and more frequent thrombotic episodes. [10][11][12] Acute systemic reactions, however, can be from coexisting HIT and heparin anaphylaxis, which should be differentiated. 13 Also, HIT antibodies in patients with HIT are not necessarily associated with thrombosis in the vascular access.…”

Section: Heparin-induced Thrombocytopenia and Hemodialysismentioning

confidence: 99%

Hemodialysis and Argatroban

Matsuo¹,

Wanaka²

2008

Semin Thromb Hemost

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Hemodialysis is indicated in uremic patients with endstage renal failure. Unfractionated heparin (heparin) is routinely used as the anticoagulant for hemodialysis, but heparin is contraindicated for dialysis of patients with antithrombin deficiency or heparininduced thrombocytopenia (HIT). With heparin, these patients often encounter clotted dialyzers and extracorporeal circuits that lead to discontinuation of dialysis. As one alternative to heparin, argatroban (a synthetic thrombin inhibitor mainly eliminated via the hepatobiliary tract) is indicated. In uremic patients with antithrombin deficiency, the alternative use of argatroban has made it feasible to carry out hemodialysis. In patients with HIT undergoing dialysis, the use of argatroban as an alternative to heparin improves thrombocytopenia and safely prevents clotting of the hemodialysis circuit. Because the elimination of argatroban does not depend on renal function and there is no need for strict dose monitoring, argatroban is recommended as a suitable anticoagulant for patients with HIT requiring hemodialysis.

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Heparin-associated antiplatelet antibodies increase morbidity and mortality in hemodialysis patients

Cited by 32 publications

References 21 publications

Use and Safety of Unfractionated Heparin for Anticoagulation During Maintenance Hemodialysis

Use and Safety of Unfractionated Heparin for Anticoagulation During Maintenance Hemodialysis

Anticoagulation strategies in extracorporeal circulatory devices in adult populations

Hemodialysis and Argatroban

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