How are hypercoagulability conditions managed in patients with calciphylaxis?

Updated: Feb 24, 2020
  • Author: Julia R Nunley, MD; Chief Editor: Dirk M Elston, MD  more...
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Conditions of hypercoagulability should be sought and addressed. Patients with documented conditions of hypercoagulability may benefit from proper and adequate anticoagulation. [78] Successful treatment of calciphylaxis with low-dose tissue plasminogen activator has been reported. [79] Laboratory evaluation of the reported patient demonstrated low antithrombin III antigen and activity, as well as low protein C antigen and activity prior to intervention with tissue plasminogen activator therapy. However, the role of anticoagulation in all cases of calciphylaxis is controversial. Random prophylactic use of warfarin or heparin is not indicated because precipitation of calciphylaxis has occurred with its use. [80, 81] In addition, most patients with ESRD have a prolonged bleeding time due to the uremic condition, and anticoagulation or tissue plasmogen activator therapy should be approached cautiously. Nonetheless, in the setting of thrombotic occlusion and cutaneous ischemia, restoration of blood flow is critical. [15] Although the anticoagulant of choice in a dialysis patient is up for debate, the two best options are most likely unfractionated heparin, and apixaban, a factor Xa inhibitor. [24]

Studies are ongoing regarding the effectiveness of vitamin K supplementation. [24]

Studies are also ongoing regarding the use of intravenous SNF472, a myoinositol hexaphosphate, that binds to calcium hydroxyapatite crystals within blood vessels, inhibiting further growth. [24]

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