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HIT Anticoagulation Dialysis — ESENeph MCQ

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HardHaemodialysisHIT Anticoagulation DialysisESENeph

A haemodialysis patient has high-probability HIT with new circuit thrombosis while confirmatory testing is pending. Which immediate anticoagulation strategy best matches UK renal guidance?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: D — Withdraw every heparin source and use monitored argatroban as a non-heparin anticoagulant

Explanation lettering: E = shown as A · A = shown as B · B = shown as C · C = shown as D · D = shown as E

C is correct. In suspected or confirmed HIT, all unfractionated and low-molecular-weight heparin exposure—including line locks and circuit products—must stop. A non-heparin anticoagulant is started when clinical probability warrants it; UK renal guidance describes argatroban, monitored with aPTT ratio, as a practical option in dialysis because it is not renally cleared. Warfarin monotherapy during active thrombocytopenic HIT can precipitate microvascular thrombosis and limb gangrene. Treatment should not be delayed for a functional assay when probability is high and thrombosis is already present.

Reference: UK Kidney Association haemodialysis guideline: anticoagulation: https://guidelines.ukkidney.org/haemodialysis/rationale-for-clinical-practice-guidelines/anticoagulation/