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.
Resumen
Successful use of a bivalirudin treatment protocol to prevent extracorporeal thrombosis in ambulatory hemodialysis patients with heparin-induced thrombocytopenia.
Por qué esto importa para la hirudoterapia
Este estudio informó sobre cinco pacientes ambulatorios en hemodiálisis con trombocitopenia inducida por heparina que recibieron un protocolo con bivalirudina para prevenir la trombosis extracorpórea durante la diálisis, sin observarse eventos hemorrágicos ni reacciones adversas durante un seguimiento medio de 4,6 meses. La bivalirudina es un inhibidor directo de la trombina derivado de la hirudina, el anticoagulante presente en la saliva de la sanguijuela medicinal, de modo que este trabajo ilustra cómo un agente inspirado en el secretoma de la sanguijuela puede ocupar un nicho clínico importante cuando la heparina está contraindicada. Los hallazgos son relevantes para la ASH porque reflejan el desempeño en el mundo real de un anticoagulante basado en hirudina en un ámbito ambulatorio crónico. Sin embargo, con sólo cinco pacientes en un único centro y sin grupo control, este reporte no puede establecer la eficacia ni la seguridad comparativa, y los resultados deben considerarse preliminares.
Citación
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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Añadido a la biblioteca ASH: May 27, 2026 · Última actualización del sitio: 18 de junio de 2026