Srpski arhiv za celokupno lekarstvo 2016 Volume 144, Issue 11-12, Pages: 654-656
https://doi.org/10.2298/SARH1612654K
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Fondaparinux monitoring in a patient with heparin-induced thrombocytopenia on hemodialysis
Kušić Jovana (Clinical Hospital Center Zemun, Department of Nephrology, Belgrade)
Kulić Andrijana (Clinical Hospital Center Zemun, Blood Bank Department, Belgrade)
Đurković Veselinka (Clinical Hospital Center Zemun, Department of Nephrology, Belgrade)
Marković Rodoljub (Clinical Hospital Center Zemun, Department of Nephrology, Belgrade)
Milačić Velja (Clinical Hospital Center Zemun, Department of Surgery, Belgrade)
Surić-Lambić Ljiljana (Clinical Hospital Center Zemun, Department of Nephrology, Belgrade)
Peković Gordana (Clinical Hospital Center Zemun, Department of Nephrology, Belgrade)
Introduction. Heparin-induced thrombocytopenia associated to hemodialysis is
rare. In case when citrate dialysis and/or non-heparin anticoagulants are not
available, only possible medication to use for anticoagulation during
hemodialysis is fondaparinux. However, laboratory monitoring of fondaparinux
based on anti-Xa activity in dialysis patients has not been sufficiently
documented yet. Case Outline. We created a local anti-factor Xa assay for
measuring fondaparinux plasma concentration and efficacy in a patient with
heparin-induced thrombocytopenia during hemodialysis. Fondaparinux given
subcutaneously increases risk of adverse events due to its extended release
and prolonged maintenance of toxic levels. When used intravenously
fondaparinux remains safe, with reached steady-state level within dialysis
and low risk of toxicity afterwards. Conclusion. Fondaparinux may be used as
an alternative anticoagulant medication during hemodialysis in patients who
develop heparin-induced thrombocytopenia. Adequate dose must be adjusted to
patients’ dry weight (0.03 mg/kg intravenously) and fondaparinux
anti-coagulation monitoring must be provided.
Keywords: heparin-induced thrombocytopenia, fondaparinux specific monitoring, hemodialysis