Abstract: TH-PO0512
Nafamostat Mesilate as an Anticoagulation Strategy for Heparin-Induced Thrombocytopenia
Session Information
- Dialysis: Novel Therapeutics and Medication Management
November 06, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Mei, Shuqin, Shanghai Changzheng Hospital, Shanghai, China
- Dai, Bing, Shanghai Changzheng Hospital, Shanghai, China
Introduction
Heparin-induced thrombocytopenia (HIT) is a life-threatening complication of heparin exposure, occurring in 0.1%–5% of patients, with end-stage renal disease (ESRD) patients at higher risk due to frequent heparin use. HIT Type II, an immune-mediated condition, results from antibodies against heparin/platelet factor 4 (PF4) complexes, leading to platelet activation and thromboembolism.
Case Description
We present a 78-year-old woman with ESRD who developed HIT Type II after low-molecular-weight heparin (LMWH) and unfractionated heparin (UFH) exposure during hemodialysis. Despite a negative PF4/heparin ELISA, a 4T score of 7 confirmed clinical HIT. She experienced thrombocytopenia (30×10*9/L) and sever thrombotic events. Heparin was discontinued, and anticoagulation transitioned to argatroban and later nafamostat mesilate due to argatroban shortage. Platelet counts normalized (223×10*9/L), and nafamostat mesilate was effective without clotting complications.
Discussion
This case highlights the challenges in HIT diagnosis, emphasizing the role of clinical evaluation over laboratory tests, and underscores the utility of nafamostat mesilate as an alternative anticoagulant in resource-limited settings. Key questions remain regarding heparin rechallenge safety, causative agent identification in multi-heparin exposure, and rapid differentiation of HIT from anaphylactoid reactions. Further studies are needed to optimize HIT management in high-risk populations.