Abstract
Two patients (one male and one female) with end stage renal disease on chronic hemodialysis were treated with recombinant human erythropoietin (r-HuEPO). Both patients developed significant clotting in the vascular access and extracorporeal circuits. Coagulation studies indicated that both patients acquired high levels of tissue-type plasminogen activator inhibitor (PAI) with deficiency in tissue-type plasminogen activator (t-PA) and consequent impaired fibrinolysis. Their fibrinolytic activity was normalized with danazol therapy in doses as low as 2–4mg/kg given orally once daily. We conclude that r-HuEPO-induced thrombosis is associated with impaired fibrinolysis due to acquired elevation of PAI which can be effectively prevented by small doses of danazol.