Hämodialyse bei Heparin-induzierter Thrombozytopenie

K.-G. Fischer

doi:10.1055/s-0038-1660376

Hämostaseologie, Table of Contents

Hamostaseologie 1999; 19(01): 42-49
DOI: 10.1055/s-0038-1660376

Übersichtsarbeiten/Review Articles

Schattauer GmbH

Hämodialyse bei Heparin-induzierter Thrombozytopenie

Authors

K.-G. Fischer

¹Abt. Innere Medizin IV, Universitätsklinik Freiburg

Abstract

Zusammenfassung

Für die Hämodialyse von Patienten mit Heparin-induzierter Thrombozytopenie ist ein alternatives Antikoagulans erforderlich. Danaparoid-Natrium, rekombinante Hirudin-Derivate oder Argatroban scheinen geeignete Wirkstoffe zu sein, da sie eine Thrombenbildung wirkungsvoll unterdrücken, ohne das Blutungsrisiko wesentlich zu erhöhen. Da diese Ergebnisse auf Erfahrungen mit einer begrenzten Anzahl von Patienten basieren, sind größere prospektive Studien notwendig, um die besten Behandlungsmodalitäten für diese Erkrankungssituation festzulegen. Die Heparin-induzierte Thrombozytopenie sollte gleichwohl heute nicht mehr länger ein lebensbedrohliches Problem für dialysepflichtige Patienten sein.

Schlüsselwörter

Heparin-induzierte Thrombozytopenie - Hämodialyse - alternative Antikoagulation - rekombinantes Hirudin - Danaparoid-Natrium - Argatroban

Full Text

References

Literatur
1 Agnelli G, Iorio A, De Angelis V, Nenci GG. Dermatan sulphate in heparin-induced thrombocytopenia. Lancet 1994; 344: 1295-6.
2 Akizawa T, Koshikawa S, Ota K, Kazama M, Mimura N, Hirasawa Y. Nafamostat mesilate: a regional anticoagulant for hemodialysis in patients at high risk for bleeding. Nephron 1993; 64: 376-81.
3 Ambühl PM, Wüthrich RP, Korte W, Schmid L, Krapf R. Plasma hypercoagulability in haemodialysis patients: impact of dialysis and anticoagulation. Nephrol Dial Transplant 1997; 12: 2355-64.
4 Beijering RJR, Ten Cate H, Nurmohamed MT, Ten Cate JW. Anticoagulants and extracorporeal circuits. Semin Thromb Hemost 1997; 23: 225-33.
5 Berry CN, Girardot C, Lecoffre C, Lunven C. Effects of the synthetic thrombin inhibitor argatroban on fibrin- or clot-incorporated thrombin: comparison with heparin and recombinant hirudin. Thromb Haemost 1996; 72: 381-6.
6 Berry CN, Lunven C, Girardot C, Lechaire I, Girard D, Charles MC, Ferrari P, O’Brien DP. Ecarin clotting time: a predictive coagulation assay for the antithrombotic activity of argatroban in the rat. Thromb Haemost 1998; 79: 228-33.
7 Bichler J, Gemmerli R, Fritz H. Studies for revealing a possible sensitization to hirudin after repeated intravenous injections in baboons. Thromb Res 1991; 61: 39-51.
8 Blaufox MD, Hampers CL, Merrill IP. Rebound anticoagulation occurring after regional heparinization for hemodialysis. ASAIO Trans 1966; 12: 207-9.
9 Boccardo P, Melacini D, Rota S, Mecca G, Boletta A, Casiraghi F, Gianese F. Individualized anticoagulation with dermatan sulphate for haemodialysis in chronic renal failure. Nephrol Dial Transplant 1997; 12: 2349-54.
10 Boon DMS, van Vliet HHDM, Zietse R, Kappers-Klunne MC. The presence of antibodies against a PF4-heparin complex in patients on haemodialysis. Thromb Haemost 1996; 76: 480.
11 Bredlich RO, Stracke S, Gall H, Proebstle TM. Heparinassoziiertes Thrombozyten-Aggregationssyndrom mit Hautnekrosen bei Hämodialyse. Dtsch Med Wschr 1997; 122: 328-32.
12 Brüggener E, Walsmann P, Markwardt F. Neutralization of hirudin anticoagulant action by DIP-thrombin. Pharmazie 1989; 44: 720-1.
13 Caruana RJ, Keep DM. Anticoagulation. In: Daugirdas JT, Ing TS. eds. Handbook of dialysis. Boston: Little, Brown; 2nd edition. 1994: 121-36.
14 Chong BH, Magnani HN. Orgaran in heparin-induced thrombocytopenia. Haemostasis 1992; 22: 85-91.
15 Danhof M, De Boer A, Magnani HN, Stiekema JC. Pharmacokinetic considerations of Orgaran (Org 10172) therapy. Haemostasis 1992; 22: 73-84.
16 De Sancho M, Lema MG, Amiral J, Ranci J. Frequency of antibodies directed against heparin-platelet factor 4 in patients exposed to heparin through chronic hemodialysis. Thromb Haemost 1996; 75: 695-6.
17 Eichler P, Olbrich K, Pötzsch B, Greinacher A. Anti-hirudin antibodies in patients treated with recombinant hirudin for more than five days, a prospective study. Thromb Haemost (Suppl.) 1997; PS 2014.
18 Finazzi G, Remuzzi G. Heparin-induced thrombocytopenia - background and implications for haemodialysis. Nephrol Dial Transplant 1996; 11: 2120-22.
19 Flanigan MJ, Pillsbury L, Sadewasser G, Lim VS. Regional hemodialysis anticoagulation: hypertonic tri-sodium citrate or anticoagulant citrate dextrose-A. Am J Kidney Dis 1996; 27: 519-24.
20 Greinacher A, Drost W, Michels I, Leitl J, Gottsmann M, Kohl HJ, Glaser M, Mueller-Eckhardt C. Heparin-associated thrombocytopenia: successful therapy with the heparinoid Org 10172 in a patient showing cross-reaction to LMW heparins. Ann Hematol 1992; 64: 40-42.
21 Greinacher A, Michels I, Mueller-Eckhardt C. Heparin-associated thrombocytopenia: the antibody is not heparin specific. Thromb Haemost 1992; 67: 545-9.
22 Greinacher A, Philippen KH, Kemkes-Matthes B, Möckl M, Mueller-Eckhardt C, Schaefer K. Heparin-associated thrombocytopenia type II in a patient with end-stage renal disease: successful anticoagulation with the low-molecular-weight heparinoid Org 10172 during haemodialysis. Nephrol Dial Transplant 1993; 8: 1176-7.
23 Greinacher A, Zinn S, Wizemann U, Birk W. Heparin-induced antibodies as a risk factor for thromboembolism and haemorrhage in patients undergoing chronic haemodialysis. Lancet 1996; 348: 764.
24 Gròtsch H, Hropot M. Degradation of rDNA hirudin and α-human thrombin hirudin complex in liver and kidney homogena-tes from rat. Thromb Res 1991; 64: 763-7.
25 Gupta AK, Kovacs MJ, Sauder DN. Heparin-induced thrombocytopenia. Ann Pharmacother 1998; 32: 55-9.
26 Haas G. Versuche der Blutauswaschung am Lebenden mit Hilfe der Dialyse. Klin Wochenschr 1925; 4: 13-4.
27 Hall AV, Clark WF, Parbtani A. Heparin-induced thrombocytopenia in renal failure. Clin Nephrol 1992; 38: 86-9.
28 Henny CP, Ten Cate H, Ten Cate JW, Surachno S, Van Bronswijk H, Wilmink JM, Ockelford PA. Use of a new heparinoid as anticoagulant during acute haemodialysis of patients with bleeding complications. Lancet 1983; 1: 890-3.
29 Horellou MH, Conard J, Lecrubier C, Samama M, Roque-D’Orbcastel O, de Fenoyl O, Di Maria G, Bernadou A. Persistent heparin induced thrombocytopenia despite therapy with low molecular weight heparin. Thromb Haemost 1984; 51: 134.
30 Huhle G, Hoffmann U, Wang L, Bayerl C, Harenberg J. Allergy and positive IgG in a patient re-exposed to r-hirudin. Ann Hematol 1998; 76 (Suppl. 01) A97.
31 Janson PA, Moake JL, Carpinito G. Aspirin prevents heparin-induced platelet aggregation in vivo. Br J Haematol 1983; 53: 166-8.
32 Janssen MJFM, Deegens JK, Kapinga TH, Beukhof JR, Huijgens PC, Van Loenen AC, Van der Meulen J. Citrate compared to low molecular weight heparin anticoagulation in chronic hemodialysis patients. Kidney Int 1996; 49: 806-13.
33 Kappa JR, Fisher CA, Berkowitz HD, Cottrel ED, Addonizio VP. Heparin-induced platelet activation in sixteen surgical patients: diagnosis and management. J Vase Surg 1987; 5: 101-9.
34 Koide M, Yamamoto S, Matsuo M, Suzuki S, Arima N, Matsuo T. Anticoagulation for heparin-induced thrombocytopenia with spontaneous platelet aggregation in a patient requiring haemodialysis. Nephrol Dial Transplant 1995; 10: 2137-40.
35 Laster J, Elfrink R, Silver D. Reexposure to heparin of patients with heparin-associated antibodies. J Vase Surg 1989; 9: 677-82.
36 Leblanc M, Roy LF, Legault L, Dufresne LR, Morin C, Thuot C. Severe skin necrosis associated with heparin in hemodialysis. Nephron 1994; 68: 133-7.
37 Lewis BE, Walenga JM, Wallis DE. Anticoagulation with Novastan (argatroban) in patients with heparin-induced thrombocytopenia and heparin-induced thrombocytopenia and thrombosis syndrome. Semin Thromb Hemost 1997; 23: 197-202.
38 Lunven C, Gauffeny C, Lecoffre C, O’Brien DP, Roome NO, Berry CN. Inhibition by argatroban, a specific thrombin inhibitor, of platelet activation by fibrin clot-associated thrombin. Thromb Haemost 1996; 75: 154-60.
39 Luzzatto G, Bertoli M, Cella G, Fabris F, Zaia B, Girolami A. Platelet count, anti-heparin/platelet factor 4 antibodies and tissue factor pathway inhibitor plasma antigen level in chronic dialysis. Thromb Res 1998; 89: 115-22.
40 Magnani HN. Heparin-induced thrombocytopenia (HIT): an overview of 230 patients treated with orgaran (Org 10172). Thromb Haemost 1993; 70: 554-61.
41 Markwardt F. Past, present and future of hirudin. Haemostasis 1991; 21: 11-26.
42 Matsuo T, Kario K, Kodama K, Okamoto S. Clinical application of the synthetic thrombin inhibitor, Argatroban (MD-805). Semin Thromb Hemost 1992; 18: 155-60.
43 Matsuo T, Kario K, Nakao K, Yamada T, Matsuo M. Anticoagulation with nafamostat mesilate, a synthetic protease inhibitor, in hemodialysis patients with a bleeding risk. Haemostasis 1993; 23: 135-41.
44 Matsuo T, Koide M, Kario K. Application of argatroban, a direct thrombin inhibitor, in heparin-intolerant patients requiring extracorporeal circulation. Artif Organs 1997; 21: 1035-38.
45 Matsuo T, Nakao K, Yamada T, Matsuo O. Effect of a new anticoagulant (MD 805) on platelet activation in the hemodialysis circuit. Thromb Res 1986; 41: 33-41.
46 Matsuo T, Yamada T, Chikahira Y, Kadowaki S. Effect of aspirin on heparin-induced thrombocytopenia (HIT) in a patient requiring hemodialysis. Blut 1989; 59: 393-5.
47 Newman PM, Swanson RL, Chong BH. IgG Binding to PF4-heparin complexes in the fluid phase and cross-reactivity with low molecular weight heparin and heparinoid. Thromb Haemost 1998; 80: 292-7.
48 Novacek G, Kapiotis S, Jilma B, Quehenberger P, Michitsch A, Traindl O, Speiser W. Enhanced blood coagulation and enhanced fibrinolysis during hemodialysis with prostacyclin. Thromb Res 1997; 88: 283-90.
49 Nowak G, Bucha E. Quantitative determination of hirudin in blood and body fluids. Sem Thromb Hemost 1996; 22: 197-202.
50 Nowak G, Bucha E, Brauns I, Czerwinski R. Anticoagulation with r-hirudin in regular haemodialysis with heparin-induced thrombocytopenia (HIT II). The first long term application of r-hirudin in a haemodialysis patient. Wien Klin Wochenschr 1997; 109: 354-8.
51 Nowak G, Bucha E, Gööck T, Thieler H, Markwardt F. Pharmacology of r-hirudin in renal impairment. Thromb Res 1992; 66: 707-15.
52 Ortel TL, Gockermann JP, Califf RM, McCann RL, O’Connor CM, Metzler DM, Greenberg CS. Parenteral anticoagulation with the heparinoid Lomoparan (Org 10172) in patients with heparin-induced thrombocytopenia and thrombosis. Thromb Haemost 1992; 67: 292-6.
53 Pinnick RV, Wiegmann TB, Diederich DA. Regional citrate anticoagulation for hemodialysis in the patient at high risk for bleeding. N Engl J Med 1983; 308: 258-61.
54 Polgár J, Eichler P, Greinacher A, Clemetson KJ. Adenosine diphosphate (ADP) and ADP receptor play a major role in platelet activation/aggregation induced by sera from heparin-induced thrombocytopenia patients. Blood 1998; 91: 549-54.
55 Riess F-C, Pötzsch B, Jäger K, Bleese N, Schaper W, Müller-Berghaus G. Elimination von rekombinantem Hirudin aus der Blutzirkulation mittels Hämofiltration. Untersuchungen im Schweinemodell. Hämostaseologie 1997; 17: 200-4.
56 Romao Jr JE, Fadil MA, Sabbaga E, Marcondes M. Haemodialysis without anticoagulant: haemostasis parameters, fibrinogen kinetic, and dialysis efficiency. Nephrol Dial Transplant 1997; 12: 106-10.
57 Roussi JH, Houbouyan LL, Goguel AF. Use of low-molecular-weight heparin in heparin-induced thrombocytopenia with thrombotic complications. Lancet 1984; 1: 1183.
58 Rylance PB, Gordge MP, Ireland H, Lane DA, Weston MJ. Haemodialysis with prostacyclin (Epoprostenol) alone. Proc Eur Dial Transplant Assoc Eur Ren Assoc 1985; 21: 281-6.
59 Samuelsson O, Amiral J, Attman P-O, Bennegârd K, Björck S, Larsson G, Tengborn L. Heparin-induced thrombocytopenia during continuous haemofiltration. Nephrol Dial Transplant 1995; 10: 1768-71.
60 Schmitt GW, Moake JL, Rudy CK, Vicks SL, Hamburger RJ. Alterations in hemostatic parameters during hemodialysis with dialyzers of different membrane composition and flow design. Platelet activation and factor VHI-related von Willebrand factor during hemodialysis. Am J Med 1987; 83: 411-18.
61 Smith MC, Danviriyasup K, Crow JW, Cato AE, Park GD, Hassid A, Dunn MJ. Prostacyclin substitution for heparin in long-term hemodialysis. Am J Med 1982; 73: 669-78.
62 Sreedhara R, Itagaki I, Lynn B, Hakim RM. Defective platelet aggregation in uremia is transiently worsened by hemodialysis. Am J Kidney Dis 1995; 25: 555-63.
63 Tholl U, Greinacher A, Overdick K, Anlauf M. Life-threatening anaphylactic reaction following parathyroidectomy in a dialysis patient with heparin-induced thrombocytopenia. Nephrol Dial Transplant 1997; 12: 2750-5.
64 Turney JH, Williams LC, Fewell MR, Parsons V, Weston MJ. Platelet protection and heparin sparing with prostacyclin during regular dialysis therapy. Lancet 1980; 2: 219-22.
65 Vanholder RC, Camez AA, Veys NM, Soria J, Mirshahi M, Soria C, Ringoir S. Recombinant hirudin: a specific thrombin inhibiting anticoagulant for hemodialysis. Kidney Int 1994; 45: 1754-9.
66 Vanholder R, Camez A, Veys N, Van Loo A, Dhondt AM, Ringoir S. Pharmacokinetics of recombinant hirudin in hemodialyzed end-stage renal failure patients. Thromb Haemost 1997; 77: 650-5.
67 Van Wyk V, Badenhorst PN, Luus HG, Kotzé HF. A comparison between the use of recombinant hirudin and heparin during hemodialysis. Kidney Int 1995; 48: 1338-43.
68 Vecino A, Navarro-Antolin J, Teruel J, Navarro J, Cesar J. Lipid composition of platelets in patients with uremia. Nephron 1998; 78: 271-3.
69 Vun CM, Evans S, Chong BH. Cross-reactivity study of low molecular weight heparins and heparinoid in heparin-induced thrombocytopenia. Thromb Res 1996; 81: 525-32.
70 Ward DM, Mehta RL. Extracorporeal management of acute renal failure patients at high risk of bleeding. Kidney Int 1993; 43: S-237-S-244.
71 Warkentin TE. Danaparoid (Orgaran) for the treatment of heparin-induced thrombocytopenia (HIT) and thrombosis: effects on in vivo thrombin and cross-linked fibrin generation, and evaluation of the clinical significance of in vitro cross-reactivity (XR) of danaparoid for HIT-IgG. Blood 1996; 88: 626a.
72 Warkentin TE, Chong BH, Greinacher A. Heparin-induced thrombocytopenia: towards consensus. Thromb Haemost 1998; 79: 1-7.
73 Warkentin TE, Kelton JG. A 14-year study of heparin-induced thrombocytopenia. Am J Med 1996; 101: 502-7.
74 Warkentin TE, Levine MN, Hirsh J, Horsewood P, Roberts RS, Gent M, Kelton JG. Heparin-induced thrombocytopenia in patients treated with low-molecular-weight heparin or unfractionated heparin. N Engl J Med 1995; 332: 1330-35.
75 Wilde MI, Markham A. Danaparoid. A review of its pharmacology and clinical use in the management of heparin-induced thrombocytopenia. Drugs 1997; 54: 903-24.
76 Yamamoto S, Koide M, Matsuo M, Suzuki S, Ohtaka M, Saika S, Matsuo T. Heparin-induced thrombocytopenia in hemodialysis patients. Am J Kidney Dis 1996; 28: 82-5.