Hemodialysis and Argatroban

Abstract

Hemodialysis is indicated in uremic patients with endstage renal failure. Unfractionated heparin (heparin) is routinely used as the anticoagulant for hemodialysis, but heparin is contraindicated for dialysis of patients with antithrombin deficiency or heparin-induced thrombocytopenia (HIT). With heparin, these patients often encounter clotted dialyzers and extracorporeal circuits that lead to discontinuation of dialysis. As one alternative to heparin, argatroban (a synthetic thrombin inhibitor mainly eliminated via the hepatobiliary tract) is indicated. In uremic patients with antithrombin deficiency, the alternative use of argatroban has made it feasible to carry out hemodialysis. In patients with HIT undergoing dialysis, the use of argatroban as an alternative to heparin improves thrombocytopenia and safely prevents clotting of the hemodialysis circuit. Because the elimination of argatroban does not depend on renal function and there is no need for strict dose monitoring, argatroban is recommended as a suitable anticoagulant for patients with HIT requiring hemodialysis.