Hemostasis in Uremia - archive.org
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Hemostasis in Uremia: Bleeding Diathesis Vs. Hypercoagulability Hussein Sheashaa, MD, FACP Professor of Nephrology, Urology and Nephrology Center and Director of Medical E-Learning Unit, Mansoura University, and Executive Director of ESNT- Virtual Academy: http://lms.mans.edu.eg/esnt/ Tanta, July 28 th , 2016
Transcript of Hemostasis in Uremia - archive.org
Hemostasis in Uremia: Bleeding Diathesis Vs.
Hypercoagulability
Hussein Sheashaa, MD, FACP Professor of Nephrology, Urology and Nephrology Center and Director of Medical E-Learning
Unit, Mansoura University, and Executive Director of ESNT- Virtual Academy:
http://lms.mans.edu.eg/esnt/
Tanta, July 28th, 2016
Outline Normal hemostasis
Uremic bleeding
Uremic thrombosis
Therapeutics
Closing
Normal Hemostasis
Steps of Platelet Activation and Aggregation
Clin J Am Soc Nephrol 8: 665–674, April, 2013
Clin J Am Soc Nephrol 8: 665–674, April, 2013
Steps of Platelet Activation and Aggregation
Am J Kidney Dis. 2013;62(3):615-632
Increased Bleeding Events
in Patients with CKD5D
Omega-3 FA
Uremic Bleeding: Prediction
Uremic Bleeding: Prediction
American Heart Journal April 2016
Uremic Bleeding: Presentations
Seminars in Dialysis 2006; 19: 317-322
GIT Bleeding
Gastrointest Endosc 2013;77:609-16.
Upper GI blood loss: Peptic ulcer disease
Lower GI blood loss: Angioectasia
Int J Clin Pract, July 2015, 69, 7, 722–728
Upper GI Bleeding: Role of ARBs (n 2744)
Dieulafoy lesion in the cardia Dieulafoy lesion in the fundus
NDT plus 2011; 3: 594-595
Uremic Bleeding: Presentations
Uremic Bleeding: Presentations
Am J Kidney Dis 2003; 41:84-89.
Uremic Bleeding: After CABG
Seminars in Dialysis—Vol 27, No 6 (November–December) 2014 pp. 618–625
Access Bleeding
Retroperitoneal Hemorrhage
Am J Kidney Dis. 2012; 60(1):62-73.
Uremic Bleeding: After Renal Biopsy
Management Algorithm of
Uremic Bleeding Uremic bleeding suspected or confirmed?
Yes
Hemodynamically stable?
Yes
Control of bleeding or
emergency surgery needed?
Yes
One dose DDAVP ± cryoprecipitate
Did this control and/or stop bleeding?
Yes
Monitor hemoglobin and hematocrit and vital signs
No
Conjugated estrogens regardless of gender
No
Can patient tolerate extra fluid?
Yes
Whole blood
Did this control and/or stop bleeding? Yes
No
Packed red blood cells, or one
dose DDAVP ± cryoprecipitate
No
Surgery?
Urgent
DDAVP
elective
Estrogen
Heparin Free Dialysis: Coated Dialyzers
Am J Kidney Dis. 2016, in press
Heparin Free Dialysis: Coated Dialyzers
J Am Soc Nephrol 22: 1856 –1862, 2011.
Anticoagulation Related Nephropathy
J Thromb Haemost. 2016 Mar;14(3):461-7
Anticoagulation Related Nephropathy
Drug Saf (2015) 38:527–533
Anticoagulation Related Nephropathy
Drug Saf (2015) 38:527–533
Anticoagulation Related Nephropathy
NKF 2016 Spring Clinical Meetings Abstracts
Anticoagulation Related Nephropathy
Clin J Am Soc Nephrol 11: 354–362, February, 2016
Invasive Procedure: Management of Antithrombotic
Nephrology Dialysis Transplantation 31 (Supplement 1): i422–i438, 2016
n 2619
Invasive Procedure: Management of Antithrombotic
Am J Health-Syst Pharm. 2016; 73(suppl 2):S5-13
Invasive Procedure: Management of Antithrombotic
Seminars in Dialysis—Vol 28, No 2 (March–April) 2015, pp.198–205
Thromboembolic Risk in
Patients with CKD
Am J Kidney Dis. 2013;62(3):615-632
How to Predict Stroke?
c
Effect of Renal Dysfunction
on AF outcome
Clin J Am Soc Nephrol 8: 962–968, 2013.
Thrombophilia: Impact on AVF
Clin J Am Soc Nephrol 7: 1584–1590, 2012
Thromboembolic Risk in
Patients with CKD
CEN Case Rep (2016) 5:74–77
Thromboembolic Risk and
Dialysis
Seminars in Dialysis—Vol 28, No 1 (January–February) 2015, pp. 35–47
Stroke and Dialysis
Clin J Am Soc Nephrol 7: 513–520, 2012.
Nephrotic Syndrome: Risk of Thrombosis
Pediatr Nephrol (2016) 31:1267–1279
Nephrotic Syndrome: Risk of Thrombosis
Clin J Am Soc Nephrol 9: 478–483, 2014
Nephrotic Syndrome: Use of Prophylactic Anti-thrombotic
J Nephrol (2016) 29:507–515
Antiphospholipid Syndrome
Hematology Am Soc Hematol Educ Program 2012;2012(1):536-540.
Choice of Anticoagulation
Choice of Anticoagulation
American Heart Journal April 2016
Anticoagulation in
ESRD
Circulation. July 2016;134:24-36
Anticoagulation in CKD
n 14 071
Seminars in Dialysis—Vol 28, No 4 (July–August) 2015, pp. 354–362
Anticoagulation in
Dialysis
Circulation. 2015 March 17; 131(11): 972–979.
Anticoagulation in
Dialysis
Am J Kidney Dis. 2015;66(1):91-98
Anticoagulation in
Dialysis
Seminars in Dialysis—Vol 28, No 5 (September–October), 2015 pp. 474–489
Anticoagulation in
Dialysis
Management Of Patients With Bleeding or Needing An Urgent
Invasive Procedure
PCC4 = four-factor prothrombin complex concentrate,
aPCC = activated prothrombin complex concentrate
Am J Health-Syst Pharm. 2016; 73(suppl 2):S5-13
Seminars in Dialysis—Vol 28, No 3 (May–June) 2015, pp. 276–281
Clopidogrel in CKD
Advances in Chronic Kidney Disease, Vol 23, No 2 (March), 2016: pp 82-90
Pharmacogenomics
Seminars in Dialysis—Vol 28, No 2 (March–April) 2015, pp.198–205
Thrombolome
Hemostasis in Uremia: Bleeding Diathesis Vs.
Hypercoagulability
Tanta, July 28th, 2016
