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Figueiredo MA, Andrade NS, Blanco Carrión A, Medina JB, Gallottini M, Ortega KL. Bleeding during tooth extraction in patients with chronic kidney disease: A cross-sectional pilot study. Oral Dis 2024; 30:2617-2624. [PMID: 37575013 DOI: 10.1111/odi.14709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 07/13/2023] [Accepted: 07/29/2023] [Indexed: 08/15/2023]
Abstract
OBJECTIVE This work measures the intra-operative bleeding in end-stage renal disease patients and assesses whether laboratory coagulation tests and nitrogenous compounds are related to a higher bleeding risk. METHODS Laboratory tests were performed on the day of surgery and some patients with thrombocytopenia and values above the normal levels of international normalised ratio (INR), thrombin time (TT) and activated partial thromboplastin time (aPTT) were identified. RESULTS Haemostatic time ranged from 2 to 35 min (mean of 8.51 min) after suture. Bleeding volume ranged from 0.02 to 67.06 mL (mean of 4.38 mL) and the bleeding volume per minute ranged from 0.05 to 2.10 mL/min (median of 0.6 mL/min). Only seven patients (16.27%) had abnormal bleeding (more than 0.6 mL/min). Spearman's coefficient showed weak correlations between bleeding volume (mL/min) and serum urea (r = 0.226), TT (r = 0.227), plasma urea (r = 0.148) and creatinine (r = 146), as well as very weak correlations with all other variables (r < 0.140) such as age, haemodialysis time, glycaemia, glycated haemoglobin, platelets, INR, aPTT and fibrinogen. CONCLUSION It was not possible to associate any laboratory test or nitrogenous compounds present in the blood and saliva with an increased bleeding.
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Affiliation(s)
| | - Natalia Silva Andrade
- Special Care Dentistry Centre, School of Dentistry, University of São Paulo, Sao Paulo, Brazil
- Department of Dentistry, Federal University of Sergipe, Lagarto, Brazil
| | - Andrés Blanco Carrión
- Oral Medicine, Oral Surgery and Implantology Unit (MedOralRes), Faculty of Medicine and Dentistry, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Janaina Braga Medina
- Special Care Dentistry Centre, School of Dentistry, University of São Paulo, Sao Paulo, Brazil
- Oral Medicine, Oral Surgery and Implantology Unit (MedOralRes), Faculty of Medicine and Dentistry, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Marina Gallottini
- Special Care Dentistry Centre, School of Dentistry, University of São Paulo, Sao Paulo, Brazil
- Department of Stomatology, School of Dentistry, University of São Paulo, Sao Paulo, Brazil
| | - Karem L Ortega
- Special Care Dentistry Centre, School of Dentistry, University of São Paulo, Sao Paulo, Brazil
- Oral Medicine, Oral Surgery and Implantology Unit (MedOralRes), Faculty of Medicine and Dentistry, University of Santiago de Compostela, Santiago de Compostela, Spain
- Department of Stomatology, School of Dentistry, University of São Paulo, Sao Paulo, Brazil
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Karki S, Aryal B, Mainali A, Uprety N, Panigrahi K, Adhikari S. Type II Heparin-Induced Thrombocytopenia: An Underrecognized Cause of Dialysis Catheter Dysfunction - A Case Report. Cureus 2023; 15:e41812. [PMID: 37575780 PMCID: PMC10422934 DOI: 10.7759/cureus.41812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2023] [Indexed: 08/15/2023] Open
Abstract
Heparin-induced thrombocytopenia (HIT) is categorized into type 1 and type 2. It causes a decrease in platelet count during or shortly after exposure to heparin. Type 1 is mild and has a non-immune mechanism. Type 2 is a hypercoagulable state resulting from anti-heparin platelet factor 4 (PF4) IgG antibodies. These antibodies cause the activation of endothelium and thrombin generation. Type 2 HIT is complicated by life-threatening thromboembolic events such as deep venous thrombosis, pulmonary embolism, and myocardial infarction. HIT remains an under-recognized cause of dialysis catheter dysfunction and thrombosis. We present a case of a 66-year-old male with recurrent dialysis catheter thrombosis secondary to Type 2 HIT. Avoiding heparin-based dialysis or switching to non-heparin-based anticoagulation or peritoneal dialysis are the possible management strategies for such patients.
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Affiliation(s)
- Sailesh Karki
- Internal Medicine, Interfaith Medical Center, Brooklyn, USA
| | - Binit Aryal
- Internal Medicine, Interfaith Medical Center, Brooklyn, USA
| | - Arjun Mainali
- Internal Medicine, Interfaith Medical Center, Brooklyn, USA
| | | | - Kalpana Panigrahi
- Internal Medicine, One Brooklyn Health, Interfaith Medical Center, Brooklyn, USA
| | - Samaj Adhikari
- Internal Medicine, Interfaith Medical Center, Brooklyn, USA
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3
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Ghimire C, Baral N, Vinjam T, Mathews SM, Baral N, Acharya B, Savarapu PK, Bashyal K, Kunadi A, Mitchell JD. In-hospital mortality of heparin-induced thrombocytopenia in end-stage kidney disease. A retrospective national population-based cohort study. Nephrology (Carlton) 2023; 28:168-174. [PMID: 36573826 DOI: 10.1111/nep.14138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 12/18/2022] [Accepted: 12/23/2022] [Indexed: 12/28/2022]
Abstract
AIM Heparin induced thrombocytopenia (HIT) and end stage kidney disease (ESKD) are independent conditions associated with increased mortality and morbidity, however, whether ESKD is an independent risk factor for increased mortality in HIT admissions is not well studied. Therefore, we aimed to compare in-hospital mortality in HIT admissions based on their ESKD status. METHODS This is a retrospective cohort study of HIT hospitalizations aged 18 and older using the 2016-2019 national inpatient sample (NIS) database. RESULTS From 2016 to 2019 we had 12 161 admissions for HIT among 28 484 087 total hospitalizations. The annual incidence rate for HIT admissions per 100 000 admissions were: 47, 46, 41.1, and 36.6, respectively (p < .001) in 2016, 2017, 2018, and 2019 respectively. Among HIT admissions, the mean age was 64.3 years, 46.8% were females, 68% were Whites and 16% were Blacks. Black patients have a significantly higher likelihood of in-hospital mortality than White patients (aOR 1.25; 95% CI: 1.06, 1.48; p = .007). Patients who did not have any insurance or self-pay had higher mortality compared to Medicare (aOR 1.64; 95% CI: 1.13, 2.38; p = .009). ESKD status was not associated with higher or lower in-hospital mortality among HIT admissions (aOR 1.002; 95% CI: 0.84, 1.19; p = .981) after adjusting for age, sex, race, and insurance status. CONCLUSION There are no higher or lower odds of in-hospital mortality in the ESKD subgroup in HIT admissions in adults. Decreasing incidence of HIT hospitalizations was seen over the years from 2016 to 2019.
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Affiliation(s)
- Calvin Ghimire
- Department of Internal Medicine, McLaren Flint/Michigan State University, Flint, Michigan, USA
| | - Nischit Baral
- Department of Internal Medicine, McLaren Flint/Michigan State University, Flint, Michigan, USA
| | - Tejaswi Vinjam
- Department of Internal Medicine, McLaren Flint/Michigan State University, Flint, Michigan, USA
| | - Simi M Mathews
- Department of Internal Medicine, McLaren Flint/Michigan State University, Flint, Michigan, USA
| | - Nisha Baral
- Department of Microbiology, Manipal College of Medical Sciences, Pokhara, Nepal
| | - Bandana Acharya
- Department of Health Sciences, Western New England University, Springfield, Massachusetts, USA
| | - Pramod K Savarapu
- Department of Medicine, Ochsner Louisiana State University Health Shreveport-Monroe Medical Center, Monroe, Louisiana, USA
| | - Krishna Bashyal
- Department of Internal Medicine, McLaren Flint/Michigan State University, Flint, Michigan, USA
| | - Arvind Kunadi
- Department of Internal Medicine, McLaren Flint/Michigan State University, Flint, Michigan, USA
| | - Joshua D Mitchell
- Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
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4
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Doi Y, Koga K, Sugioka S, Inoue Y, Arisato T, Nishioka K, Ishihara T, Sugawara A. Heparin-induced thrombocytopenia among incident hemodialysis patients anticoagulated with low molecular weight heparin: A single-center retrospective study. Nefrologia 2021; 41:356-358. [PMID: 36165343 DOI: 10.1016/j.nefroe.2020.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 05/20/2020] [Indexed: 06/16/2023] Open
Affiliation(s)
- Yohei Doi
- Department of Nephrology, Osaka Red Cross Hospital, Japan.
| | - Kenichi Koga
- Department of Nephrology, Osaka Red Cross Hospital, Japan
| | - Sayaka Sugioka
- Department of Nephrology, Osaka Red Cross Hospital, Japan
| | - Yui Inoue
- Department of Nephrology, Osaka Red Cross Hospital, Japan
| | | | | | - Takeshi Ishihara
- Department of Clinical Engineering, Osaka Red Cross Hospital, Japan
| | - Akira Sugawara
- Department of Nephrology, Osaka Red Cross Hospital, Japan
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Duayer IF, Araújo MJCLN, Nihei CH, Barcelos MAF, Braga O, Britto ZML, Elias RM. Dialysis-related thrombocytopenia: a case report. J Bras Nefrol 2021; 44:116-120. [PMID: 33657204 PMCID: PMC8943872 DOI: 10.1590/2175-8239-jbn-2020-0109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 11/04/2020] [Indexed: 12/24/2022] Open
Abstract
Thrombocytopenia is frequently observed in hemodialysis patients, and its correct investigation and control remain a challenge. It is estimated that during the hemodialysis session there is a drop of up to 15% in the platelet count, with recovery after the end of treatment. This reduction in platelets is due to platelet adhesion and complement activation, regardless of the membrane material. Several studies with platelet surface markers demonstrate increased platelet activation and aggregation secondary to exposure to cardiopulmonary bypass. This case report describes a patient on hemodialysis who developed severe thrombocytopenia during hospitalization. Investigation and exclusion of the most common causes were carried out: heparin-related thrombocytopenia, adverse drug reaction, hypersplenism, and hematological diseases. Afterwards, the possibility of hemodialysis-related thrombocytopenia was raised, since the fall was accentuated during the sessions with partial recovery after the dialyzer change. Attention to the sterilization method and dialyzer reuse must be considered for correction. In the current case, reusing the dialyzer minimized the drop in platelet counts associated with hemodialysis.
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Affiliation(s)
| | | | | | | | - Osni Braga
- Hospital Nove de Julho, São Paulo, SP, Brasil
| | | | - Rosilene Mota Elias
- Hospital Nove de Julho, São Paulo, SP, Brasil.,Universidade de São Paulo, Hospital das Clínicas, São Paulo, SP, Brasil
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Doi Y, Koga K, Sugioka S, Inoue Y, Arisato T, Nishioka K, Ishihara T, Sugawara A. Heparin-induced thrombocytopenia among incident hemodialysis patients anticoagulated with low molecular weight heparin: A single-center retrospective study. Nefrologia 2020; 41:356-358. [PMID: 32807578 DOI: 10.1016/j.nefro.2020.05.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 05/13/2020] [Accepted: 05/20/2020] [Indexed: 10/23/2022] Open
Affiliation(s)
- Yohei Doi
- Department of Nephrology, Osaka Red Cross Hospital, Japan.
| | - Kenichi Koga
- Department of Nephrology, Osaka Red Cross Hospital, Japan
| | - Sayaka Sugioka
- Department of Nephrology, Osaka Red Cross Hospital, Japan
| | - Yui Inoue
- Department of Nephrology, Osaka Red Cross Hospital, Japan
| | | | | | - Takeshi Ishihara
- Department of Clinical Engineering, Osaka Red Cross Hospital, Japan
| | - Akira Sugawara
- Department of Nephrology, Osaka Red Cross Hospital, Japan
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Guo Q, Lou Y, Liu L, Luo P. How Can I Manage Thrombocytopenia in Hemodialysis Patient? A Review. Ther Apher Dial 2019; 24:352-360. [PMID: 31661590 DOI: 10.1111/1744-9987.13448] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 10/24/2019] [Accepted: 10/25/2019] [Indexed: 12/13/2022]
Affiliation(s)
- Qiaoyan Guo
- Department of NephrologyJilin University Second Hospital Changchun China
| | - Yan Lou
- Department of NephrologyJilin University Second Hospital Changchun China
| | - Lihua Liu
- Department of NephrologyJilin University Second Hospital Changchun China
| | - Ping Luo
- Department of NephrologyJilin University Second Hospital Changchun China
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Taguchi K, Ishiyama K, Ide K, Ohira M, Tahara H, Ohdan H. Simultaneous Liver-Kidney Transplantation in Patient with a History of Heparin-Induced Thrombocytopenia: A Case Report and Literature Review. AMERICAN JOURNAL OF CASE REPORTS 2019; 20:980-987. [PMID: 31285416 PMCID: PMC6640169 DOI: 10.12659/ajcr.916717] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Patient: Male, 58 Final Diagnosis: Heparin-induced thrombocytopenia Symptoms: Liver and kidney failure Medication: — Clinical Procedure: Simultaneous liver-kidney transplantation Specialty: Transplantology
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Affiliation(s)
- Kazuhiro Taguchi
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima City, Hiroshima, Japan.,Institute for Clinical Research, National Hospital Organization, Kure Medical Center and Chugoku Cancer Center, Kure, Hiroshima, Japan
| | - Kohei Ishiyama
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima City, Hiroshima, Japan.,Department of Surgery, National Hospital Organization, Kure Medical Center and Chugoku Cancer Center, Kure, Hiroshima, Japan
| | - Kentaro Ide
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima City, Hiroshima, Japan
| | - Masahiro Ohira
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima City, Hiroshima, Japan
| | - Hiroyuki Tahara
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima City, Hiroshima, Japan
| | - Hideki Ohdan
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima City, Hiroshima, Japan
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