Abstract: . . .  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 . . .
. . .  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): 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) as anticoagulant in intensive care patients treated with continuous hemodialysis. Kidney Int suppl 1999; (72): S46-50.  . . .
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