Managing acute kidney injury becomes significantly more complex when the patient also has heparin-induced thrombocytopenia (HIT) and requires renal replacement therapy (RRT). The presence of HIT fundamentally changes how anticoagulation during dialysis must be handled.
This protocol addresses patients with AKI who have been diagnosed with heparin-induced thrombocytopenia and need renal replacement therapy. In this population, standard heparin-based circuit anticoagulation is contraindicated, requiring a carefully selected alternative approach.
The protocol requires stopping all heparin immediately. Anticoagulation during RRT must be maintained with an agent from an alternative class — either a direct thrombin inhibitor or a Factor Xa inhibitor — with agent selection guided by the patient's specific clinical context.
DOI: 10.1159/000339789
In a patient with heparin-induced thrombocytopenia (HIT), all heparin must be stopped and we recommend using direct thrombin inhibitors (such as argatroban) or Factor Xa inhibitors (such as danaparoid or fondaparinux) rather than other or no anticoagulation during RRT.
In a patient with HIT who does not have severe liver failure, we suggest using argatroban rather than other thrombin or Factor Xa inhibitors during RRT.
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