在慢性血液透析患者中,肝素诱导的血小板缺血
Rachelle Hamadi1, Fouad Sakr1, Hussam Aridi1
1Internal Medicine Department, Staten Island University Hospital, Staten Island, NY, USA.
概括
肝素诱导的血小板缺血 (HIT) 是末期病 (ESRD) 患者的一种严重并发症. 在ESRD中管理HIT需要仔细考虑由于肝素的替代抗凝剂.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學.
- 血液学 血液学 血液学
- 药理学 药理学是指药理学的学科.
背景情况:
- 氨酸诱导的血小板缺血 (HIT) 是一种由氨酸暴露引发的原血小板免疫疾病.
- HIT表现出一系列症状,从无症状抗体到严重的血栓事件,携带显著的发病率和死亡率.
- 在末期病 (ESRD) 患者中,HIT的发生率和临床影响仍然未得到充分研究.
研究的目的:
- 确定在末期病 (ESRD) 患者中治疗氨酸诱导的血小板缺血 (HIT) 的挑战和考虑因素.
- 对被诊断患有HIT的ESRD患者评估替代性抗凝剂策略.
主要方法:
- 在ESRD和抗凝血的背景下对HIT现有文献的审查.
- 对替代抗凝剂选择的分析,重点关注与功能障碍相关的药理学特征.
- 在ESRD中讨论从肝素转换为替代抗凝剂的风险益处评估.
主要成果:
- 由于在血液透析期间经常暴露于肝素,ESRD患者患HIT的风险增加.
- 替代抗凝剂在ESRD中存在挑战,原因是成本,可用性和清除问题.
- 阿尔加特罗班 (肝脏清除) 和阿皮克萨班 (最小的脏清除) 被确定为潜在的合适替代品.
- 希特抗体的短暂性质和氨酸重新引入的可能性需要进一步调查.
结论:
- 在ESRD患者中,HIT构成了重大诊断和管理挑战.
- 在考虑在这个人群中从肝素转换为替代抗凝剂时,仔细的风险效益分析至关重要.
- 需要进一步的研究来优化ESRD患者的HIT管理策略.
相关概念视频
01:24Hemodialysis II: Procedure and Complications
43
DialyzersA hemodialysis (HD) dialyzer is a plastic cartridge containing thousands of parallel hollow fibers, which serve as semipermeable membranes. These fibers are typically made from cellulose-based or other synthetic materials. During HD, blood is pumped into the top of the cartridge and distributed among these fibers. Simultaneously, dialysis fluid, known as dialysate, is introduced into the bottom of the cartridge, bathing the outside of the fibers. Across the semipermeable membrane,...
43
01:30Anticoagulant Drugs: Low-Molecular-Weight Heparins
773
Hemostasis is a crucial process that prevents excessive blood loss from damaged blood vessels. It involves various mechanisms such as vasoconstriction, platelet adhesion and activation, and fibrin formation. The importance of each mechanism depends on the type of vessel injury. In contrast, thrombosis is the abnormal formation of a blood clot within the blood vessels, leading to potential complications if the clot obstructs blood flow. Thrombosis can be caused by increased coagulability of the...
773
01:29Venous Thrombosis III: Interprofessional Care
12
Venous thrombosis requires effective prevention and treatment strategies to improve patient outcomes and reduce potential complications.Prevention StrategiesHealthcare providers must prioritize preventing venous thromboembolism (VTE) for all adult patients upon admission. Interventions depend on bleeding and thrombosis risk, medical history, current medications, diagnoses, planned procedures, and patient preferences. Patients on bed rest should change positions every two hours and, if not...
12
01:27Dialysis
391
Renal failure occurs when the kidneys lose their ability to filter waste products from the blood effectively. It can be classified into two types: acute renal failure (ARF) and chronic renal failure (CRF).
Acute kidney injury develops suddenly and can be caused by pre-renal causes (e.g., hypovolemia, shock), intrinsic renal causes (e.g., acute tubular necrosis), or post-renal causes (e.g., urinary obstruction). In contrast, chronic renal failure progresses gradually over time and is often...
Acute kidney injury develops suddenly and can be caused by pre-renal causes (e.g., hypovolemia, shock), intrinsic renal causes (e.g., acute tubular necrosis), or post-renal causes (e.g., urinary obstruction). In contrast, chronic renal failure progresses gradually over time and is often...
391
01:25Hemodialysis I: Introduction
72
Hemodialysis (HD) is a medical treatment that artificially removes waste products, excess fluids, and toxins from the blood when the kidneys are no longer able to perform these functions effectively. In this process, blood is filtered through a semipermeable membrane, allowing for the selective removal of waste while preserving necessary components like blood cells and proteins. Hemodialysis is typically performed in patients with end-stage renal disease (ESRD) or severe kidney...
72
01:25Hemodialysis III: Nursing Management
52
The nursing management of a patient undergoing hemodialysis includes several critical steps, starting with a thorough assessment before the procedure.Before the Hemodialysis ProcedureFirst, record the patient's vital signs—blood pressure, heart rate, respiratory rate, and temperature—to establish a baseline. This baseline is essential for detecting conditions such as hypotension that could impact the patient's response to dialysis. Document the patient's pre-dialysis weight, as this...
52