Abstract
The decision for an anticoagulant for renal replacement therapy (RRT) in patients with acute renal failure and heparin-induced thrombocytopenia (HIT) has to be made carefully. Based on results from the literature argatroban is favoured in patients without hepatic dysfunction, referring to its short halftime and easy feasable monitoring. In the case of coexsisting hepatic disorder, danaparoid provides a safe alternative therapy. However, long halftime and the difficult elimination of the substance are unfavourable. Lepirudin represents another possible anticoagulant therapy. Bleeding complications and monitoring of the ecarin clotting time imposes limitations. Experiences with bivalirudin, fondaparinux and prostaglandines are limited and future trials will have to determine the significance of their application in RRT in HIT patients. Furthermore it has to be proven whether the combination of alternative anticoagulants with citrate prolongates circuit halftime of CVVH.
MeSH terms
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Acute Kidney Injury / therapy*
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Anticoagulants / administration & dosage
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Anticoagulants / adverse effects*
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Arginine / analogs & derivatives
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Blood Coagulation Tests
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Chondroitin Sulfates / administration & dosage
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Chondroitin Sulfates / adverse effects
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Citrates / administration & dosage
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Citrates / adverse effects
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Critical Care / methods*
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Dermatan Sulfate / administration & dosage
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Dermatan Sulfate / adverse effects
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Diagnostic Errors
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Dose-Response Relationship, Drug
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Epoprostenol / administration & dosage
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Epoprostenol / adverse effects
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Fondaparinux
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Hemofiltration / methods*
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Heparin / administration & dosage
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Heparin / adverse effects*
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Heparin, Low-Molecular-Weight / administration & dosage
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Heparin, Low-Molecular-Weight / adverse effects*
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Heparitin Sulfate / administration & dosage
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Heparitin Sulfate / adverse effects
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Hirudins / administration & dosage
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Hirudins / adverse effects
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Humans
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Iloprost / administration & dosage
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Iloprost / adverse effects
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Pipecolic Acids / administration & dosage
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Pipecolic Acids / adverse effects
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Polysaccharides / administration & dosage
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Polysaccharides / adverse effects
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Recombinant Proteins / administration & dosage
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Recombinant Proteins / adverse effects
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Sodium Citrate
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Sulfonamides
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Thrombocytopenia / chemically induced*
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Thrombocytopenia / diagnosis
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Thrombosis / chemically induced
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Thrombosis / diagnosis
Substances
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Anticoagulants
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Citrates
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Heparin, Low-Molecular-Weight
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Hirudins
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Pipecolic Acids
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Polysaccharides
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Recombinant Proteins
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Sulfonamides
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Sodium Citrate
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Dermatan Sulfate
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Heparin
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Chondroitin Sulfates
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Heparitin Sulfate
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Arginine
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danaparoid
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Epoprostenol
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argatroban
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Fondaparinux
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Iloprost
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lepirudin