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[Heparin-induced trombocytopenia: pathogenesis, clinical manifestations and management in hemodialysis].
[heparin-induced thrombocytopenia]
Heparin
has
remained
the
most
commonly
used
anticoagulant
in
hemodialysis
patients
(
HD
)
.
Its
use
is
usually
safe
but
,
in
some
cases
,
important
adverse
effects
can
occur
.
Heparin-induced
thrombocytopenia
(
HIT
)
is
an
immuno-mediated
condition
due
to
the
formation
of
PF
4
/
heparin
/
IgG
complex
leading
to
the
activation
of
platelets
and
coagulative
cascade
.
The
consequent
prothrombotic
hypercoagulable
state
may
cause
venous
or
arterial
thrombosis
,
skin
gangrene
and
acute
platelet
activation
syndrome
.
Clinical
and
laboratory
findings
may
be
suggestive
for
HIT
,
but
formal
diagnosis
requires
the
demonstration
of
the
presence
of
circulating
antibodies
.
Clinical
management
is
complex
including
the
withdrawal
of
any
form
of
heparin
and
the
administration
of
anticoagulants
.
In
addition
,
since
anticoagulation
is
routinely
required
to
prevent
clotting
of
the
dialysis
lines
and
membranes
,
in
HD
patients
presenting
HIT
it
is
mandatory
to
establish
heparin-free
anticoagulation
strategies
.
Thus
,
the
use
of
citrate
,
direct
thrombin
inhibitors
or
eparinods
have
been
proposed
as
alternative
anticoagulation
approaches
in
HIT
.
Here
,
we
review
the
most
important
pathogenic
factors
and
clinical
features
of
HIT
occurring
in
HD
patients
.