Successful use of a bivalirudin treatment protocol to prevent extracorporeal thrombosis in ambulatory hemodialysis patients with heparin-induced thrombocytopenia
Research article published in Hemodialysis international (2015)
Abstract
Heparin-induced thrombocytopenia (HIT) is an uncommon problem in hemodialysis (HD) patients. There have been a few reports on the use of lepirudin, argatroban, or danaparoid in the management of extracorporeal thrombosis (ECT) during dialysis in these patients, because heparin is contraindicated. Here, we report the first long-term use of bivalirudin to prevent ECT. Our study was conducted at Fahd Bin Jassim Kidney Center in Doha, Qatar. All patients diagnosed with HIT were included. A bivalirudin treatment protocol was developed with the initial dosage and dosage adjustments based on the value of activated partial thromboplastin time (aPTT), the risk of bleeding, and the recurrence of ECT. Eight patients were positive for HIT AB. Among them, three were excluded: two due to the use of warfarin for atrial fibrillation and one due to a negative repeat HIT AB test with no ECT. Five patients who were positive for HIT AB and experienced recurrent ECT events during dialysis were included. These patients were monitored while on bivalirudin protocol for a mean of 4.6 ± 2 months, during which they received a mean number of HD treatments of 66 ± 24. There were no bleeding events or adverse reactions related to bivalirudin during the study. Here, we report the first long-term successful use of a bivalirudin protocol to prevent ECT in ambulatory HD patients with HIT. This protocol allowed for a simple dosing initiation with easy adjustment based on weight, aPTT, and recurrence of ECT events. The protocol provided excellent safety.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Summary
Successful use of a bivalirudin treatment protocol to prevent extracorporeal thrombosis in ambulatory hemodialysis patients with heparin-induced thrombocytopenia.
Why This Matters for Hirudotherapy
This study reported on five ambulatory hemodialysis patients with heparin-induced thrombocytopenia who received a bivalirudin protocol to prevent extracorporeal thrombosis during dialysis, with no bleeding events or adverse reactions observed over a mean follow-up of 4.6 months. Bivalirudin is a direct thrombin inhibitor derived from hirudin, the anticoagulant found in medicinal leech saliva, so this work illustrates how a leech-secretome-inspired agent can fill an important clinical niche when heparin is contraindicated. The findings are relevant to ASH because they reflect real-world performance of a hirudin-based anticoagulant in a chronic outpatient setting. However, with only five patients at a single center and no control group, this report cannot establish efficacy or comparative safety, and the results should be considered preliminary.
Citation
Successful use of a bivalirudin treatment protocol to prevent extracorporeal thrombosis in ambulatory hemodialysis patients with heparin-induced thrombocytopenia
Al-Ali FS et al. · Hemodialysis international, 2015
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