Hemodialysis complicated by heparin-induced thrombocytopenia (HIT) is a rare event requiring anticoagulation with direct-thrombin inhibitors. Contaminant calcific uremic arteriolopathy (calciphylaxis) further complicates this situation due to the possibility that warfarin anticoagulation may exacerbate skin necrosis. The authors report a patient with renal failure and calciphylaxis who developed HIT after starting hemodialysis. She was successfully treated with Argatroban.
Warkentin TEHeparin-induced thrombocytopenia: IgG-mediated platelet activation, platelet microparticle generation, and altered procoagulant/anticoagulant balance in the pathogenesis of thrombosis and venous limb gangrene complicating heparin-induced thrombocytopenia. Transfus Med Rev. 1996;10:249-258.
2.
Warkentin TE , Kelton JGA 14-year study of heparin-induced thrombocytopenia . Am J Med.1996;101:502-507.
3.
Weismann RE, Tobin RWArterial embolism occurring during systemic heparin therapy. AMA Arch Surg.1958; 76:219-277.
Warkentin TE , Sheppard JA, Horsewood P., Simpson PJ, Moore JC, Kelton JGImpact of the patient population on the risk for heparin-induced thrombocytopenia. Blood. 2000;96:1703-1708.
6.
Warkentin TE , Kelton JGTemporal aspects of heparin-induced thrombocytopenia . N Engl J Med.2001;344: 1286-1292.
Messmore H., Jeske W., Wehrmacher W., Walenga J.Benefit-risk assessment of treatments for heparin-induced thrombocytopenia . Drug Saf.2003;26:625-641.
9.
Warkentin TE , Levine MN, Hirsh J., et al. Heparin-induced thrombocytopenia in patients treated with low-molecular-weight heparin or unfractionated heparin . N Engl J Med.1995 ;332:1330-1335.
10.
Boon DM, Van Vliet HH, Zietse R., Kappers-Klunne MCThe presence of antibodies against a PF4-heparin complex in patients on hemodialysis . Thromb Haemost.1996;76:480.
11.
De Sancho M. , Lema MG, Amiral J., Rand J.Frequency of antibodies directed against heparin-platelet factor 4 in patients exposed to heparin through chronic hemodialysis [letter] . Thromb Haemost.1996;75:695-696.
12.
Luzzatto G. , Bertoli M., Cella G.Platelet count, antiheparin/platelet—factor 4 antibodies and tissue factor pathway inhibitor plasma antigen level in chronic dialysis. Thromb Res.1998;89:115-122.
13.
Sitter T., Spannagl M., Banas B.Prevalence of heparin-induced PF4-heparin antibodies in hemodialysis patients . Nephron. 1998;79:245-246.
14.
Greinacher A., Zinn S., Wizemann S., Birk UWHeparin-induced antibodies as a risk for thromboembolism and haemorrhage in patients undergoing hemodialysis [letter]. Lancet. 1996;348:764.
15.
Pena de la Vega L., Miller RS, Benda MM, et al. Association of heparin-dependent antibodies and adverse outcomes in hemodialysis patients: a population-based study. Mayo Clin Proc.2006;81:263.
16.
Yamamoto S. , Koide M., Matsuo M.Heparin-induced thrombocytopenia in hemodialysis patients. Am JKidney. 1996 ;25:82-85.
17.
O'Shea SI, Sands JJ, Nudo SAFrequency of anti-heparin-platelet factor 4 antibodies in hemodialysis patients and correlation with recurrent vascular access thrombosis. Am J Hematol.2002;69:72-73.
18.
Sreedhara R. , Itagaki I., Lynn B., Hakim RMDefective platelet aggregation in uremia is transiently worsened by hemodialysis. Am J Kidney Dis.1995;25:555-563.
19.
Vecino A., Navarro-Antolin J., Teruel J., Navarro J., Cesar J.Lipid composition of platelets in patients with uremia. Nephron . 1998;78:271-273.
20.
Moberg PQ, Geary VM, Sheikh FMHeparin-induced thrombocytopenia: a possible complication of heparin-coated pulmonary artery catheters. J Cardiothorac Anesth. 1990;4:226-228.
21.
Kadidal VV, Mayo DJ, Horne MKHeparin-induced thrombocytopenia (HIT) due to heparin flushes: a report of three cases. J Intern Med.1999;246:325-329.
22.
Warkentin TE , Greinacher A.Heparin-induced thrombocytopenia: recognition, treatment, and prevention: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest. 2004;126(suppl): 311S-337S.
23.
Price PA, Faus SA, Williamson MKWarfarin causes rapid calcification of elastic lamellae in rat arteries and heart valves. Arterioscler Thromb Vasc Biol. 1988;18: 1400-1407.
24.
Wallin R., Cain D., Sane DCMatrix Gla protein synthesis and gamma-carboxylation in the aortic vessel wall and proliferating vascular smooth muscle cells—a cell system which resembles the system in bone cells. Thromb Haemost.1999;82:1764-1767.
25.
Denton MD, Mauiyyedi S., Bazari H.Heparin-induced skin necrosis in a patient with end-stage renal disease and functional protein S deficiency. Am J Kidney Dis.2001;21:289-293.
