RESUMO
Dialysis patients who are continually exposed to heparin are at risk for heparin-induced thrombocytopenia (HIT). Heparin-induced antibodies have been reported to occur in 0-12% of hemodialysis (HD) patients. The diagnosis or suspicion of HIT in this patient population requires careful confirmation of the diagnosis and substitution of heparin with an alternate anticoagulant for dialysis. Alternate agents such as the direct thrombin inhibitors (hirudin and argatroban) are available, but careful dosing and monitoring of the anticoagulant effect are required. Despite careful dosing, hemorrhagic complications have occurred with these agents. Unfortunately there are limited options for treatment of hemorrhagic complications and no specific antidotes are available for the direct thrombin inhibitors. In this report the currently available alternatives to heparin for dialysis, including dosing and monitoring recommendations, are reviewed.
Assuntos
Anticoagulantes/efeitos adversos , Heparina/efeitos adversos , Hirudinas/análogos & derivados , Trombina/antagonistas & inibidores , Trombocitopenia/induzido quimicamente , Anticoagulantes/administração & dosagem , Arginina/análogos & derivados , Ensaios Clínicos como Assunto , Fibrinolíticos/uso terapêutico , Heparina/administração & dosagem , Heparinoides/uso terapêutico , Terapia com Hirudina/métodos , Humanos , Fragmentos de Peptídeos/uso terapêutico , Ácidos Pipecólicos/uso terapêutico , Proteínas Recombinantes/uso terapêutico , Diálise Renal/métodos , SulfonamidasRESUMO
PURPOSE OF REVIEW: The focus of the review is to delineate protocols for catheter removal, catheter replacement and duration of therapy when a catheter-related infection occurs, and to demonstrate possible means of preventing such infections. RECENT FINDINGS: The evidence supporting these views will be discussed in the light of our current practice. SUMMARY: Cuffed tunneled hemodialysis catheters have evolved for wide use as both temporary and semi-permanent hemodialysis access. The primary barriers to long-term catheter use are catheter-related infection and catheter dysfunction. Catheter-related infection has emerged as the primary barrier to long-term catheter use. Under both circumstances, however, catheter replacement or some form of intervention is often needed. Because of this, catheters are often removed and replaced, but the duration of therapy and the timing of replacement of these catheters is not completely clear.
