Abstract

Heparin is the most commonly used anticoagulant for patients undergoing hemodialysis, therefore these patients are at risk of developing heparin-induced thrombocytopenia (HIT). Importance of an accurate diagnosis and an early intervention to reduce the mortality of HIT are usually emphasized. A patient with end stage renal disease who developed HIT (platelet count nadir, 42×109/L) on the ninth day of continuous renal replacement therapy (CRRT) performed with routine heparin was reported. His 4Ts score was 6 points with high probability of developing HIT, and the heparin-platelet factor 4 antibody was positive. He was diagnosed with HIT, and heparin was suspended immediately. Anticoagulation with citrate dialysis and argatroban was immediately conducted to prevent thrombosis. The patient’s platelet count recovered to101×109/L after twelve days of heparin discontinuation, and there was no thromboembolic complication. HIT is a potentially fatal clinical disease which can occur after even exposure to small doses of heparin products. Once HIT is suspected, all forms of heparins should be promptly discontinued. Argatroban and bivalirudin are the ideal alternative anticoagulants for patients with renal dysfunction. Other therapeutic methods such as citrate dialysis and peritoneal dialysis should also be considered.