Step1. Recognition of HIT is most important:
1. Unexpected clotting of dialyzer/circuit, and thrombotic occlusion of arteriovenous fistula/grafting despite optimal dose of heparin infusion
2. Absence of other cause of clotting:
such slow blood flow, high hematocrit, high ultrafiltration rate, intradialytic blood and b blood product transfusion, intradialytic lipid transfusion
3. Check primary thrombocytopenia |
Step 2. Emergent protocol for suspected HIT patient:
1. Stop dialysis immediately, and replace whole extracorporeal circuit with a new one
2. Restart dialysis with argatroban (lepirudin)
3. Confirm by visible inspection that there is no clot in the circuit once starting an alternative to heparin
4. Avoid heparin flush on non-session days |
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