Al-Ali Fadwa Saqr, Elsayed Mohammed, Khalifa Sabah, Abdulla Aisha Elsayed, Tolba Hoda, Bouanane Hisham, Ibrahim Rania, Hamad Abdullah
Division of Nephrology, Fahad Bin Jassim Kidney Center, Hamad General Hospital, Doha, Qatar.
Division of Pharmacology, Fahad Bin Jassim Kidney Center, Hamad General Hospital, Doha, Qatar.
Hemodial Int. 2016 Apr;20(2):204-7. doi: 10.1111/hdi.12379. Epub 2015 Oct 26.
Heparin-induced thrombocytopenia (HIT) is an uncommon problem in hemodialysis (HD) patients. There have been a few reports on the use of lepirudin, argatroban, or danaparoid in the management of extracorporeal thrombosis (ECT) during dialysis in these patients, because heparin is contraindicated. Here, we report the first long-term use of bivalirudin to prevent ECT. Our study was conducted at Fahd Bin Jassim Kidney Center in Doha, Qatar. All patients diagnosed with HIT were included. A bivalirudin treatment protocol was developed with the initial dosage and dosage adjustments based on the value of activated partial thromboplastin time (aPTT), the risk of bleeding, and the recurrence of ECT. Eight patients were positive for HIT AB. Among them, three were excluded: two due to the use of warfarin for atrial fibrillation and one due to a negative repeat HIT AB test with no ECT. Five patients who were positive for HIT AB and experienced recurrent ECT events during dialysis were included. These patients were monitored while on bivalirudin protocol for a mean of 4.6 ± 2 months, during which they received a mean number of HD treatments of 66 ± 24. There were no bleeding events or adverse reactions related to bivalirudin during the study. Here, we report the first long-term successful use of a bivalirudin protocol to prevent ECT in ambulatory HD patients with HIT. This protocol allowed for a simple dosing initiation with easy adjustment based on weight, aPTT, and recurrence of ECT events. The protocol provided excellent safety.
肝素诱导的血小板减少症（HIT）在血液透析（HD）患者中是一个不常见的问题。由于肝素是禁忌的，已有一些关于在这些患者透析期间使用比伐芦定、阿加曲班或达那肝素治疗体外血栓形成（ECT）的报道。在此，我们报告首次长期使用比伐芦定预防ECT。我们的研究在卡塔尔多哈的法赫德·本·贾西姆肾脏中心进行。纳入了所有诊断为HIT的患者。制定了比伐芦定治疗方案，初始剂量和剂量调整基于活化部分凝血活酶时间（aPTT）值、出血风险和ECT复发情况。8例患者HIT AB检测呈阳性。其中3例被排除：2例因使用华法林治疗房颤，1例因重复HIT AB检测阴性且无ECT。纳入了5例HIT AB检测呈阳性且在透析期间经历ECT复发事件的患者。这些患者在接受比伐芦定治疗方案期间平均监测4.6±2个月，在此期间他们平均接受了66±24次HD治疗。研究期间未发生与比伐芦定相关的出血事件或不良反应。在此，我们报告首次长期成功使用比伐芦定方案预防门诊HD合并HIT患者的ECT。该方案起始给药简单，可根据体重、aPTT和ECT事件复发情况轻松调整。该方案具有出色的安全性。
