Abstract: . . .  The Ulster Medical Society, 2006. 90 The Ulster Medical Journal www.ums.ac.uk are probably efficient in HIT (plasmapheresis, high dose intravenous gammaglobulin, antiaggregants, prostacyclin analogues, thrombolytic therapy as well as thromboembolectomy) could not be used in our patient because of her unstable clinical condition. In a dose-escalation study, a bolus dose of 0.08 mg/kg lepirudin before haemodialysis was found to be effective. In patients with HIT and acute renal failure, a reduced dosage according to the degree of renal dysfunction is proposed but the optimal dosage schedule to induce therapeutic effect without bleeding is still unknown. Bolus doses as low as 0.005mg/kg have been advocated in anuric patients. Recovering renal function however, can lead to the need for drastically increased doses. 10 In our patient, intermittent intravenous administration of lepirudin once daily according to APTT values for forty days was effective. After commencing lepirudin the patient didnt experience any other thrombotic episode, haemodialysis sessions were uneventful and bleeding did not occur. It was surprising that partial recanalization of the right renal artery was gradually restored with the right kidney regaining partial function allowing the patient to become dialysis independent. conflIct of Interest The authors have no conflict of interest. references 1. Warkentin TE. Heparin-induced thrombocytopenia: pathogenesis and management. Br J Haematol 2003; 121: 535-5. 2. Meyer O, Salama A, Pittet N, Schwind P. Rapid detection of heparin- induced platelet antibodies with particle gel immunoassay (ID-HPF4). Lancet 354(9189): 1525-26. 3. Lubenow N, Greinacher A. Hirudin in heparin-induced thrombocytopenia. semin Thromb Hemost 2002; 28(5): 431-8. 4. Potzsch B, Madlener K, Seelig C, Riess CF, Greinacher A, Muller- Berghaus G. Monitoring of r-hirudin anticoagulation during cardiopulmonary bypass assessment of the whole blood ecarin clotting time. Thromb Haemost 1997; 77(5): 920-5. 5. Chuang P, Parikh C, Reilly RF. A case review: anticoagulation in hemodialysis patients with heparin-induced thrombocytopenia. am J Nephrol 2001; 21(3): 226-31. 6. Dager WE, White RH. Use of lepirudin in patients with heparin- induced thrombocytopenia and renal failure requiring hemodialysis. ann pharmacother 2001; 35(7-8): . . .
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