Evidence-based treatment recommendations for uremic bleeding

被引:147
作者
Hedges, Stephanie J.
Dehoney, Sarah B.
Hooper, Justin S.
Amanzadeh, Jamshid
Busti, Anthony J.
机构
[1] Texas Tech Univ, Hlth Sci Ctr, Sch Pharm, Dallas, TX 75216 USA
[2] Univ Mississippi, Med Ctr, Jackson, MS 39216 USA
[3] Med Univ S Carolina, Sch Pharm, Charleston, SC 29425 USA
[4] Trinity Mother Frances Hosp, Tyler, TX USA
[5] N Texas Vet Affairs Hlth Care Syst, Dept Pharm, Dallas, TX USA
[6] N Texas Vet Affairs Hlth Care Syst, Div Nephrol, Dallas, TX USA
[7] Univ Texas, SW Med Ctr, Dallas, TX USA
来源
NATURE CLINICAL PRACTICE NEPHROLOGY | 2007年 / 3卷 / 03期
关键词
bleeding time; desmopressin; erythropoietin; uremia; von Willebrand Factor;
D O I
10.1038/ncpneph0421
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Uremic bleeding syndrome is a recognized consequence of renal failure and can result in clinically significant sequelae. Although the pathophysiology of the condition has yet to be fully elucidated, it is believed to be multifactorial. This article is a review of both the normal hemostatic and homeostatic mechanisms that operate within the body to prevent unnecessary bleeding, as well as an in-depth discussion of the dysfunctional components that contribute to the complications associated with uremic bleeding syndrome. As a result of the multifactorial nature of this syndrome, prevention and treatment options can include one or a combination of the following: dialysis, erythropoietin, cryoprecipitate, desmopressin, and conjugated estrogens. Here, these treatment options are compared with regard to their mechanism of action, and onset and duration of efficacy. An extensive review of the clinical trials that have evaluated each treatment is also presented. Lastly, we have created an evidence-based treatment algorithm to help guide clinicians through most clinical scenarios, and answered common questions related to the management of uremic bleeding.
引用
收藏
页码:138 / 153
页数:16
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