Background: In patients with end stage renal disease, the risk of thrombotic events increases. Anticoagulant treatment for these patients are also challenging due to altered pharmacokinetics, increase risk of bleeding and limited evidence based data due to exclusion of these patiens in clinical trials. In patients with history of HIT the challenge is higher.

Aims: To describe a case report of a patient on hemodialysis, history of HIT with emergency access with subclavian vein and treatment of venous thrombosis in subclavian vein.

Methods: A case report of 56 years old female with Diabetic Kidney Disease came with dyspnea due to metabolic acidosis. Hemodialysis performed with access through right subclavian vein. Two days post hemodyalisis showed swelling in both arms, the right one more severe. The D Dimer increased and Doppler US showed thrombosis in subclavian vein. Active cancer and arrhythmia were rule out. Fondaparinux 2,5 mg started for 7 days. The swelling subsides and the subclavian cathether were replaced with AV shunt. No subsequent bleeding and the patient were discharged on day 9 with scheduled regular HD with Fondaparinux as anticoagulation.

Results: Fondaparinux safety in renal failure is limited, however the constraint of anticoagulant drugs availability force the use of it. Case reports showed fondaparinux can be used in hemodyalisis patient with heparin induced thrombocytopenia. Fondaparinux adjust dose doses ranged from 2.5 mg every 48-72 hours to 0.03mg/kg daily, with several studies adjusting doses with anti-Xa levels.

Conclusions: Fondaparinux may be a reasonable treatment option for patients with VTE on dialysis.

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ISTH Congress Abstracts - https://abstracts.isth.org/abstract/management-strategy-of-venous-thrombosis-in-a-dialysis-patient-with-history-of-heparin-induced-thrombocytopenia/