Abstract: . . .  the initial thrombotic episode, renal dialysis was stopped. At that time we stopped lepirudin and the patient was commenced on oral anticoagulation with Warfarin (target INR 2.5 to 3.5). Two years later, the patient is in excellent clinical condition with stable renal function. dIscussIon Heparin-induced thrombocytopenia (HIT) is an immune-mediated clinicopathological syndrome where the diagnosis should be based on the concurrence of an appropriate clinical picture together with detection of platelet activating and/or platelet factor 4 (PF4) dependent antibodies. These antibodies (most frequently IgG) activate platelets causing release of prothrombotic platelet-derived microparticles which in turn promote thrombin generation. Thrombosis appears to be due to heparin-like . . .
. . .  post-operative day. Ten days after the surgical procedure and twelve days after the angiography, the patient was readmitted to our hospital because of an acute substernal pain with electrocardiogram findings suggestive of acute myocardial infarction. On clinical examination an intense oedema with pain and redness on her right forearm was noticed. A duplex ultrasound study revealed thrombosis in the right subclavian vein. The laboratory tests were as follows: haemoglobin 7.1g/dl, white cell count 22.5x10 9 /l (neutrophils 88%, lymphocytes 8%, monocytes 4%), platelets 45x10 9 /l, coagulation tests were normal except for the presence of elevated D-Dimers, urea 38.5mmol/l (normal range 3.5-14), creatinine 371.3mol/l (normal range 44.3-105), lactate dehydrogenase (LDH) 750 iu/l . . .
. . .  thrombocytopenia and renal failure requiring hemodialysis. ann pharmacother 2001; 35(7-8): 885-90. 7. Schneider T, Heuer B, Deller A, Boesken WH. Continuous haemofiltration with r-hirudin (lepirudin) as anticoagulant in a patient with heparin induced thrombocytopenia (HIT II). Wien Klin Wochenschr 2000; 112(12): 552-5. 8. Whelen S, Carr ME Jr. Use of recombinant hirudin in heparin-induced thrombocytopenia and thrombosis (HITT) and renal failure: a case report. angiology 2001; 52(10): 711-5. 9. 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(10): 354-8. 10. Fischer KG, van de Loo A, Bohler J. Recombinant hirudin (lepirudin) . . .
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