Heparin-induced thrombocytopenia in a hemodialysis patient treated with fondaparinux: nephrologists between two fires

Hemodial Int. 2013 Apr;17(2):320-3. doi: 10.1111/j.1542-4758.2012.00710.x. Epub 2012 May 28.

Abstract

Heparin-induced thrombocytopenia (HIT) is caused by heparin exposure and presents with reduced platelet count. Patients undergoing hemodialysis (HD) treatment have increased risk of developing HIT due to prolonged exposure to unfractionated heparin or low-molecular weight heparin. We report a 79-year-old male patient with end-stage renal disease who developed type-II HIT during maintenance HD. Platelet count of the patient decreased gradually and antiplatelet factor IV antibody was found to be positive. The patient was treated with fondaparinux and continued heparin-free HD. Unfortunately, despite favorable initial response without any thrombotic episodes, the patient died due to severe sepsis complicated by gastrointestinal hemorrhage.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Anticoagulants / therapeutic use*
  • Fatal Outcome
  • Fondaparinux
  • Heparin / adverse effects*
  • Humans
  • Kidney Failure, Chronic / blood
  • Kidney Failure, Chronic / therapy
  • Male
  • Platelet Count
  • Polysaccharides / therapeutic use*
  • Renal Dialysis / adverse effects
  • Renal Dialysis / methods*
  • Thrombocytopenia / blood
  • Thrombocytopenia / chemically induced*
  • Thrombocytopenia / drug therapy*

Substances

  • Anticoagulants
  • Polysaccharides
  • Heparin
  • Fondaparinux