Anticoagulant therapy in a hemodialysis patient at high risk of thrombotic and hemorrhagic complications. Case report

An attempt to preserve the knee joint in a patient on hemodialysis with stage IV lower limb ischemia high risk of thrombotic and hemorrhagic complications is presented. Multifocal atherosclerosis extensive occlusion arteries leg ruled out technical possibility revascularization. The refused proposed hip amputation. was made perform amputation at level leg. Required therapy aimed treatment prevention complications, optimization microcirculation ischemic limb. For this purpose, prolonged blockade sciatic femoral nerves, combined anticoagulant therapy, alprostadil were performed. Therapy antithrombotic vasoactive drugs not effective complicated by state persistent hypocoagulation an episode bleeding. Amputation thigh performed according vital indications after correction hypocoagulation. lack clinical recommendations for critical patients 5 chronic kidney disease requires individual approach choice their doses, monitoring blood coagulation using integral method assessing hemostasis system thromboelastography.