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- 저자 : ( Luis Javier Marfil Rivera ) (검색결과 1 건)
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( Hector Raul Ibarra Sifuentes ),( Guillermo Ruben Garcia Delgado ),( Roberto Monreal Robles ),( Daniel Gallegos Arguijo ),( Perla Rocio Colunga Pedraza ),( Luis Javier Marfil Rivera ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
A 50-years-old woman came to the emergency room due to uremic syndrome; she was referred to start renal replacement therapy. Her past medical history was signifi - cant for long-standing type 2 diabetes and hypertension (evolving over 4 years), both conditions irregularly treated. On the night of her admission, a right femoral Mahurkar catheter was placed through an ultrasonography guided technique, and hemodialysis was thus started. Unfractionated heparin (UFH) was used as a bolus at the start of the session, subcutaneous UFH was also used as thromboprophylaxis during her hospital stay. On day 4 the second hemodialysis was performed. She clinically improved after 6 days of hospitalization, and was switched from hemodialysis to peritoneal dialysis. At admission, moderate thrombocytopenia (118 K/uL) was found, which was exhaustively investigated without identifying its cause. On day 10, showed at the physical examination painful, pitting edema, and limitation in walking. Deep venous thrombosis was then diagnosed by color Doppler ultrasonography, and anticoagulation with UFH and warfarin was started. The next day platelet count (PC) fell by 67% (absolute PC: 23. 6 K/uL), so early-onset HIT was suspected. According to the 4Ts score, our patient had a high pretest probability for HIT, therefore UFH and warfarin were discontinued. Treatment options were discussed with the patient in detail; we obtained an informed consent from her, and started her on apixaban. On day 15 her PC improved to 75 K/uL; and on day 18 to 128 K/uL. A low-dose warfarin (5 mg qd) was started together with apixaban for fi ve days. The INR was maintained within the therapeutic range during her hospital stay. On day 22 apixaban was discontinued, and she continued solely on warfarin. Prior to discharge her PC was entirely recovered (231 K/uL).
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