Danaparoid for cardiopulmonary bypass in patients with previous heparin‐induced thrombocytopenia

Gillis, Shmuel; Merin, Gideon; Zahger, Doron; Deeb, Maher; Drenger, Benjamin; Hyam, Esti; Eldor, Amiram

doi:10.1046/j.1365-2141.1997.2633080.x

Cited by 24 publications

(11 citation statements)

References 10 publications

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“…A dose of 7500 u i.v./1500 u to the prime, then 1500 u i.v. if anti‐Xa assay <0.8 u/ml (Gillis et al , 1997) minimizes excess bleeding. Danaparoid is undetectable by ACT, poorly reversed by protamine, and has a long half‐life, features not popular with surgical teams.…”

Section: Cpb and Hit: Alternatives To Heparinmentioning

confidence: 99%

Cardiac bypass haemostasis: putting blood through the mill

Bevan

1999

Br J Haematol

101

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Section: Cpb and Hit: Alternatives To Heparinmentioning

confidence: 99%

Cardiac bypass haemostasis: putting blood through the mill

Bevan

1999

Br J Haematol

101

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“…48,[70][71][72] Various dosing regimes have been proposed for the patient and to prime the pump. Current recommendations are that anti-Xa levels should be maintained in the range of 1 U/mL throughout the procedure by intra-operative monitoring [73][74][75] with dose adjustments for bleeding or thrombosis. 76 After surgery, danaparoid is discontinued until hemostasis is attained and then resumed to achieve anti-Xa levels of 0.15-0.8 U/mL.…”

Section: Argatrobanmentioning

confidence: 99%

Platelets: An Update on Diagnosis and Management of Thrombocytopenic Disorders

McCrae¹,

Bussel²,

Mannucci³

et al. 2001

Hematology

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Thrombocytopenia in the pregnant patient may result from a number of causes, most of which involve either immune-mediated platelet destruction or platelet consumption. Many of these disorders share clinical and laboratory features, making accurate diagnosis difficult. Moreover, uterine evacuation is indicated in the therapy of some disorders, while in others alternative interventions may allow the pregnancy to be carried to term. These and other issues are discussed as part of a comprehensive review of the differential diagnosis and management of thrombocytopenia in pregnancy.The term "refractory ITP" is used with reference to two distinct groups of patients: 1) patients in whom the platelet count cannot be easily increased, including those who are poorly responsive to initial single agent treatment, and 2) those with persistent thrombocytopenia despite the use of conventional therapies. An approach to management of the former group will be presented, followed by a discussion of patients with chronic refractory ITP. The latter will include presentation of new data on the role of Helicobacter pylori in ITP and whether its treatment ameliorates thrombocytopenia, as well as the use of rituximab and other modalities.Thrombotic microangiopathies such as thrombotic thrombocytopenic purpura (TTP) are rare, but life threatening causes of thrombocytopenia. Ultralarge multimers of von Willebrand factor (vWF) aggregate platelets intravascularly, and congenital or immune-mediated deficiencies of a metalloprotease that cleaves these ultra-large multimers may cause TTP. However, little information exists concerning the behavior of this protease in other physiological and pathological conditions. Levels of this protease have now been measured in healthy individuals of different ages, full-term newborns, pregnant women and a patients with variety of pathologic conditions, and these data will be reviewed herein.Heparin-induced thrombocytopenia/thrombosis (HIT/T) remains the most common antibodymediated, drug-induced thrombocytopenic disorder, and a leading cause of morbidity and mortality. Based on clinical correlations and murine models, there is increasing evidence that antibodies to complexes between platelet factor 4 (PF4) and heparin cause HIT/T, and the molecular composition of the relevant antigen has also become better defined. However, the introduction of sensitive ELISAs to measure anti-PF4/heparin antibodies has complicated diagnosis in some settings in which the incidence of such antibodies in unaffected patients exceeds the incidence of the disease. In addition, the FDA approval of Lepirudin and Argatroban has expanded the repertoire of agents available for therapy of HIT/T and may change the approach to management of asymptomatic patients with thrombocytopenia. However, the optimal use of these drugs in commonly encountered settings remains in evolution, and a need for alternative approaches to prevention and treatment is evident.

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“…A lower incidence of cross-reactivity (10% to 20%) is seen with danaparoid, a factor Xa-inhibiting heparinoid (30). Other non-heparin anticoagulants include the glycoprotein (GP) IIb/IIIa inhibitors, the direct thrombin inhibitors (hirudin, recombinant hirudin-lepirudin and bivalirudin, and argatroban), and the defibrinogenating enzyme (ancrod) (31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43) …”

Section: Discussionmentioning

confidence: 97%