Heparin-induced thrombocytopenia in renal failure

A 35-year-old patient with symptomatic chronic renal failure secondary to hereditary nephritis underwent heparinization during urgent hemodialysis. Subclavian catheter insertion was complicated by staphylococcal septicemia which precluded Gore-tex graft placement. Arteriovenous fistula failed immediately postoperatively and thrombectomy was required. Heparin-induced thrombocytopenia was suspected and the test was strongly positive. Acetyl salicylic acid (ASA) 40 mg, was used with heparin for dialysis, and there were no episodes of gastrointestinal hemorrhage or access site thrombosis. The use of very low-dose ASA in this setting is reported.