CONJUGATED ESTROGENS (CE) TO REDUCE BLEEDING IN UREMICS

Bleeding is a major complication of uremia. Both cryoprecipitate and desmopressin favourably infuence clinical bleeding, but the former carries the risk of transmitting blood-borne infectious diseases and both have a short duration of action. We recently demonstrated in a controlled study that CE effectively shortened bleeding time (BT) (the best available marker of clinical bleeding) in uremics. The effect of CE on BT is long lasting. Thus CE might represent an alternative to cryoprecipitate or desmopressin when long-lasting hemostatic” competence is required. In the present study we followed for two years 6 uremic patients on chronic hemodialysis with severe bleeding tendence, often requiring blood transfusion. In the first year each hemorrhagic episode was treated only with a replacement therapy, while the subsequent year CE infusions (Emopremarin, 0.6 mg/Kg/die for 5 consecutive days) were given after each bleeding episode. The incidence of hemorrhagic episodes/year and the number of blood transfusions/year decreased from 39 to 8 and from 26 to 9 respectively. No side effects of CE have been noted. Results of this study indicate that CE are effective and safe in treating hemorrhages of uremics.