Semin Thromb Hemost 2008; 34: 056-061
DOI: 10.1055/s-0028-1086083
© Thieme Medical Publishers

Hemodialysis and Argatroban

Takefumi Matsuo1 , Keiko Wanaka2
  • 1Hyogo Prefectural Awaji Hospital, Hyogo, Japan
  • 2Kobe Research Projects on Thrombosis and Haemostasis, Kobe, Japan
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
28. Oktober 2008 (online)

ABSTRACT

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 heparin-induced 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.

REFERENCES

  • 1 Okamoto S, Hijikata A, Kikumoto R et al.. Potent inhibition of thrombin by the newly synthesized arginine derivative No. 805. The importance of stereo-structure of its hydrophobic carboxamide portion.  Biochem Biophys Res Commun. 1981;  30(101) 440-446
  • 2 Matsuo T, Yamada T, Yamanashi T, Kodama K. Choice of anticoagulant in a congenital antithrombin III (AT III)-deficient patient with chronic renal failure undergoing regular haemodialysis.  Clin Lab Haematol. 1989;  11 213-219
  • 3 Ota K, Akizawa T, Hirasawa Y, Agishi T, Matsui N. Effects of argatroban as an anticoagulant for haemodialysis in patients with antithrombin III deficiency.  Nephrol Dial Transplant. 2003;  18 1623-1630
  • 4 Yamamoto S, Koide M, Matsuo M et al.. Heparin-induced thrombocytopenia in hemodialysis patients.  Am J Kidney Dis. 1996;  28 82-85
  • 5 Hutchison C A, Dasgupta I. National survey of heparin-induced thrombocytopenia in the haemodialysis population of the UK population.  Nephrol Dial Transplant. 2007;  22 1680-1684
  • 6 Matsuo T, Kobayashi H, Matsuo M et al.. Frequency of anti-heparin-PF4 complex antibodies (HIT antibodies) in uremic patients on chronic intermittent hemodialysis.  Pathophysiol Haemost Thromb. 2006;  35 445-450
  • 7 Davenport A. Sudden collapse during haemodialysis due to immune-mediated heparin-induced thrombocytopaenia.  Nephrol Dial Transplant. 2006;  21 1721-1724
  • 8 Hartman V, Malbrain M, Daelemans R, Meersman P, Zachée P. Pseudo-pulmonary embolism as a sign of acute heparin-induced thrombocytopenia in hemodialysis patients: safety of resuming heparin after disappearance of HIT antibodies.  Nephron Clin Pract. 2006;  104 c143-c148
  • 9 Charif R, Davenport A. Heparin-induced thrombocytopenia: an uncommon but serious complication of heparin use in renal replacement therapy.  Hemodial Int. 2006;  10 235-240
  • 10 Mureebe L, Coats R D, Silliman W R, Shuster T A, Nichols W K, Silver D. Heparin-associated antiplatelet antibodies increase morbidity and mortality in hemodialysis patients.  Surgery. 2004;  136 848-853
  • 11 Nakamoto H, Shimada Y, Kanno T, Wanaka K, Matsuo T, Suzuki H. Role of platelet factor 4-heparin complex antibody (HIT antibody) in the pathogenesis of thrombotic episodes in patients on hemodialysis.  Hemodial Int. 2005;  9(Suppl 1) S2-S7
  • 12 Pena de la Vega L, Miller R S, Benda M M et al.. Association of heparin-dependent antibodies and adverse outcomes in hemodialysis patients: a population-based study.  Mayo Clin Proc. 2005;  80 995-1000
  • 13 Tejedor Alonso M A, López Revuelta K, García Bueno M J et al.. Thrombocytopenia and anaphylaxis secondary to heparin in a hemodialysis patient.  Clin Nephrol. 2005;  63 236-240
  • 14 O'Shea S I, Sands J J, Nudo S A, Ortel T L. Frequency of anti-heparin-platelet factor 4 antibodies in hemodialysis patients and correlation with recurrent vascular access thrombosis.  Am J Hematol. 2002;  69 72-73
  • 15 Carrier M, Knoll G A, Kovacs M J, Moore J C, Fergusson D, Rodger M A. The prevalence of antibodies to the platelet factor 4-heparin complex and association with access thrombosis in patients on chronic hemodialysis.  Thromb Res. 2007;  120 215-220
  • 16 Chuang P, Parikh C, Reilly R F. A case review: anticoagulation in hemodialysis patients with heparin-induced thrombocytopenia.  Am J Nephrol. 2001;  21 226-231
  • 17 Song X, Huhle G, Wang L, Hoffmann U, Harenberg J. Generation of anti-hirudin antibodies in heparin-induced thrombocytopenic patients treated with r-hirudin.  Circulation. 1999;  100 1528-1532
  • 18 Eichler P, Friesen H J, Lubenow N, Jaeger B, Greinacher A. Anti-hirudin antibodies in patients with heparin-induced thrombocytopenia treated with lepirudin: incidence, effects on aPTT, and clinical relevance.  Blood. 2000;  96 2373-2378
  • 19 Vanholder R, Camez A, Veys N, Van Loo A, Dhondt A M, Ringoir S. Pharmacokinetics of recombinant hirudin in hemodialyzed end-stage renal failure patients.  Thromb Haemost. 1997;  77 650-655
  • 20 Walenga J M, Ahmad S, Hoppensteadt D, Iqbal O, Hursting M J, Lewis B E. Argatroban therapy does not generate antibodies that alter its anticoagulant activity in patients with heparin-induced thrombocytopenia.  Thromb Res. 2002;  105 401-405
  • 21 Matsuo T, Nakao K, Yamada T, Matsuo O. A new thrombin inhibitor MD805 and thrombocytopenia encountered with heparin hemodialysis.  Thromb Res. 1986;  44 247-251
  • 22 Fischer K G. Essentials of anticoagulation in hemodialysis.  Hemodial Int. 2007;  11 178-189
  • 23 Matsuo T, Wanaka K. Management of uremic patients with heparin-induced thrombocytopenia requiring hemodialysis.  Clin Appl Thromb Hemost. 2007;  , Dec [E-pub ahead of print]
  • 24 Reddy B V, Grossman E J, Trevino S A, Hursting M J, Murray P T. Argatroban anticoagulation in patients with heparin-induced thrombocytopenia requiring renal replacement therapy.  Ann Pharmacother. 2005;  39 1601-1605
  • 25 Hursting M J, Alford K L, Becker J C et al.. Novastan (brand of argatroban): a small-molecule, direct thrombin inhibitor.  Semin Thromb Hemost. 1997;  23 503-516
  • 26 Matsuo T, Kusano H, Wanaka K, Ishihara M, Oyama A. Heparin-induced thrombocytopenia in a uremic patient requiring hemodialysis: an alternative treatment and reexposure to heparin.  Clin Appl Thromb Hemost. 2007;  13 182-187
  • 27 Matsuo T, Matuo M, Wanaka K, Sakai R. Heparin re-exposure after heparin-induced thrombocytopenia in a chronic hemodialysis patient.  Clin Lab Haematol. 2003;  25 333-334

Keiko WanakaPh.D. 

Kobe Research Projects on Thrombosis and Haemostasis, 3-15-18 Asahigaoka

Tarumi-ku, Kobe 655-0033, Japan

eMail: VYA10606@nifty.com