Clinical Analysis Of Heparin-induced Thrombocytopenia In Patients Treated With Blood Purification

ObjectiveHeparin-induced thrombocytopenia(HIT)is a significant complication in patients with end-stage renal disease(ESRD)during maintenance blood purification therapy(CBP).Therefore,this study was conducted to investigate the clinical characteristics of HIT in patients with end-stage renal disease(ESRD)and the relationship between different heparin types and arteriovenous internal fistula(AVF)thrombosis.MethodsA retrospective analysis of 2017 to 2020 in the first affiliated hospital of chongqing medical university renal medicine blood purification treatment,according to a 2017 HIT the expert consensus in our country,using 4 ts judge was HIT with inclusion criteria rating system,will collect summarized the clinical data of patients,collect patients’general information,clinical manifestation,heparin drugs usage,use,whether to merge changes before and after platelet values,thrombosis,treatment,and so on and so forth.Statistical methods were t test,Mann-Whitney U test,chi-square test and Fisher exact probability method.ResultsThirty patients were included in the study,with a morbidity of 3.6%(male 2.8%,female 4.6%)and an age of(58.4±14.95)years.The primary disease was chronic glomerulonephritis.There were 15 patients who received common heparin(UFH)and low molecular weight heparin(LMWH).The values of 30 patients before thrombocytopenia were all above 100×10~9/L,with an average of 125.8±29.95×10~9/L,and a decrease rate of more than 30%(53%±12%)was observed in 2-10 days(6.53±2.77days).Seven patients were admitted with manifestations of AVF thrombosis,and 12 patients were treated with dialysis for the first time and had not used heparin before.In 29 patients,platelets recovered gradually 5-19 days after discontinuing heparin drugs.One died of respiratory failure of his own.None of the 30 patients had bleeding events during the period when platelet count was below the normal range.There was a difference between the first dialysis and the long-term maintenance dialysis(P<0.05),and HIT was more likely to occur during the first dialysis.There was a statistical difference between HIT patients and non-HIT patients(P<0.05),and HIT patients were prone to form AVF thrombosis.Patients with HIT were divided into thrombus group and non-thrombus group in terms of age,platelet level,gender,heparin type,dialysis time and primary disease(P>0.05),but there were differences in contact time with heparin(P<0.05).The shorter the time of decrease,the more likely thrombosis was to form.ConclusionThe platelet value should be monitored regularly in patients with CBP,especially in patients on dialysis for the first time.When patients with long-term CBP frequently appear AVF formation,repeated coagulation in dialyzer and pipeline,and thrombocytopenes with unknown causes such as infection of the blood system and other drugs are excluded,HIT should be considered.4TS score should be improved as soon as possible,and HIT antibody detection should be further improved when the possibility of intermediate or high is indicated.Discontinuation of heparin drugs and replacement of anticoagulant therapy can reduce the disability rate and fatality rate of HIT.