Patients with subacute HIT A, subacute HIT B, or remote HIT who are undergoing renal replacement therapy face a distinct clinical challenge: they are not otherwise receiving anticoagulation but require it to prevent thrombosis of the dialysis circuit. The choice of anticoagulation modality in this setting is specifically addressed by evidence-based guideline recommendations.
Subacute HIT A, subacute HIT B, or remote HIT — receiving renal replacement therapy, not otherwise receiving anticoagulation, and requiring anticoagulation to prevent thrombosis of the dialysis circuit.
Guideline recommendations for this scenario favour a regional anticoagulation strategy for the dialysis circuit over systemic or heparin-based options. The protocol specifies the preferred anticoagulation approach and the critical clinical caveat that governs when it is and is not appropriate.
DOI: 10.1182/bloodadvances.2018024489
In patients with subacute HIT A, subacute HIT B, or remote HIT who are receiving renal replacement therapy, are not otherwise receiving anticoagulation, and require anticoagulation to prevent thrombosis of the dialysis circuit, the ASH guideline panel suggests regional citrate rather than heparin or other non-heparin anticoagulants (conditional recommendation; very low certainty in the evidence about effects).
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