Catastrophic complication following heparin therapy

Pantula, Narasinga Rao; Vedula, Kartik

doi:10.1177/0218492313493428

Cited by 3 publications

(4 citation statements)

References 7 publications

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“…A total of 19 reports were collected with 33 pediatric patients recruited into this study. 2,7,[9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] Patients were at the age of 3.0 ±0.5 years (n=32). Patients' gender was not stated for 2 cases.…”

Section: Resultsmentioning

confidence: 99%

“…In 22 (66.7%) patients, 25 positive diagnostic tests for confirmation of HIT were reported: a positive antiheparin platelet factor 4 antibody in 15 (60%) cases, 2,9,[11][12][13][15][16][17][18][19][20][22][23][24][25] on POD 6.8 ±4.1 (n=5), 2,18,21,22 a positive particle gel immunoassay in 5 (20%) patients on POD 9.0 ±4.2 (n=4), and a positive heparin-induced platelet activation assay in 5 (20%) patients on POD 11.8 ±5.7 (n=4). 21,22,24 Of the patient setting, 10 (30.3%) patients did not have thrombosis, whereas 23 (69.7%) patients did ( 2 =10.2, p=0.003).…”

Section: Resultsmentioning

confidence: 99%

“…In the remaining 22 (66.7%) patients, heparin discontinuation with the use of substitute anticoagulant was applied in 16 (72.7%) patients, 2,9,11,12,[14][15][16][19][20][21]23,25 heparin discontinuation in 4 (18.2%), 10,13,22 use of substitute anticoagulant (bivalirudin) in 1 (4.5%), 21 and multiple platelet transfusions in 1 (4.5%) patient. 17 In the above 16 patients, the substitute anticoagulants were bivalirudin (n=6), 9,20,21,23 tirofiban with subsequent lepirudin, 19 lepirudin (n=3), 12,15,16 argatroban (n=4), 2,14,25 antiplatelet (n=1), 11 and fondaparinux (n=1). 7 In one of them, tirofiban failed to increase the activated partial thromboplastin time to the target value.…”

Section: Resultsmentioning

confidence: 99%

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Heparin-induced Thrombocytopenia in Pediatrics Following Cardiopulmonary Bypass

Yuan¹

2019

J Coll Physicians Surg Pak

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Heparin-induced thrombocytopenia (HIT) is an immune-mediated response to heparin administration. HIT following cardiopulmonary bypass (CPB) procedures has not been clearly delineated in pediatric populations. By comprehensive retrieval of the pertinent literature published since 2000, 19 reports were collected with 33 pediatric patients recruited into this study. A female predominance was noted in this patient setting. HIT occurred after a mean heparin exposure of 2.8 times. Pediatric HIT following CPB showed different features from that with no CPB, by a longer span on postoperative day 1-16, and a significant negative correlation between the platelet count and time of occurrence of thrombocytopenia on postoperative day 1-8. The thrombus formation developed on postoperative day 13. Heparin discontinuation and use of coganulant substitute are the important treatments of choice. In HIT patients, continued heparin use may cause patient death or recurrence of HIT. HIT-related thrombosis was present in 69.6% of the patients with similar incidence rates of arterial and venous thrombosis; and the thrombosis could be managed by medical, surgical or device explant methods. The direct thrombin inhibitors lepirudin, argatroban and bivalirudin as well as the factor Xa inhibitor danaparoid can be used safely in most of the pediatric patients. The event-free survival rate of this patient setting was 69.7%.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Heparin-induced Thrombocytopenia in Pediatrics Following Cardiopulmonary Bypass

Yuan¹

2019

J Coll Physicians Surg Pak

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“…27 Multiple thrombotic events are not uncommon, 27 and patients with catastrophic outcomes involving multiple vascular beds have been reported. 28,29 Although HIT most often presents with macrovascular thrombosis, severe HIT complicated by DIC can be associated with limb ischemia and microvascular thrombosis, even in the absence of deep vein thrombosis (DVT) or treatment with warfarin. 30,31 In addition, patients with acute HIT who are treated with warfarin can develop warfarin-induced skin necrosis 32 and/or venous limb gangrene, 33 due to microvascular occlusions secondary to acquired deficiency of protein C.…”

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confidence: 99%

How I treat catastrophic thrombotic syndromes

Ortel

Erkan

Kitchens

2015

Blood

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Catastrophic thrombotic syndromes are characterized by rapid onset of multiple thromboembolic occlusions affecting diverse vascular beds. Patients may have multiple events on presentation, or develop them rapidly over days to weeks. Several disorders can present with this extreme clinical phenotype, including catastrophic antiphospholipid syndrome (APS), atypical presentations of thrombotic thrombocytopenic purpura (TTP) or heparin-induced thrombocytopenia (HIT), and Trousseau syndrome, but some patients present with multiple thrombotic events in the absence of associated prothrombotic disorders. Diagnostic workup must rapidly determine which, if any, of these syndromes are present because therapeutic management is driven by the underlying disorder. With the exception of atypical presentations of TTP, which are treated with plasma exchange, anticoagulation is the most important therapeutic intervention in these patients. Effective anticoagulation may require laboratory confirmation with anti–factor Xa levels in patients treated with heparin, especially if the baseline (pretreatment) activated partial thromboplastin time is prolonged. Patients with catastrophic APS also benefit from immunosuppressive therapy and/or plasma exchange, whereas patients with HIT need an alternative anticoagulant to replace heparin. Progressive thrombotic events despite therapeutic anticoagulation may necessitate an alternative therapeutic strategy. If the thrombotic process can be controlled, these patients can recover, but indefinite anticoagulant therapy may be appropriate to prevent recurrent events.

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Heparin

2015

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Catastrophic complication following heparin therapy

Cited by 3 publications

References 7 publications

Heparin-induced Thrombocytopenia in Pediatrics Following Cardiopulmonary Bypass

Heparin-induced Thrombocytopenia in Pediatrics Following Cardiopulmonary Bypass

How I treat catastrophic thrombotic syndromes

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