Danaparoid sodium (Orgaran®) in four children with heparin‐induced thrombocytopenia type II

Abstract

We report on four children with heparin‐induced thrombocytopenia type II. In three patients, therapy with unfractionated heparin was associated with development of cardiac thrombi or with thrombosis progression up to the inferior vena cava or with aggravation of peripheral arterial occlusion. In the fourth child, the disease was recognized early on, and no complication occurred. Heparin‐induced thrombocytopenia type II was confirmed by heparin‐induced platelet activation assay and/or heparin/platelet factor 4‐ELISA. Concomitant elevated antiphospholipid antibodies were seen in all patients. Danaparoid sodium applied at a dosage of between 1.2 and 7.1 U/kg/h stopped the disease progression in each patient. Three children had a clinical recovery with partial recanalization, but for the child with peripheral arterial occlusion disease, amputation of some of the toes became necessary. Conclusion: Our data indicate that heparin‐induced thrombocytopenia type II is a potential life‐ threatening disease in children and danaparoid sodium is beneficial in this age group.

Prevalence of heparin-dependent platelet antibodies in children after cardiopulmonary bypass*

“…Typical options include direct thrombin inhibitors such as lepirudin and argatroban or a heparinoid such as danaparoid. There is less familiarity in using these agents in children (33)(34)(35)(36)(37)(38)(39), and adverse effects such as major bleeding have been reported (37)(38)(39). In addition, danaparoid, which is currently not available in the United States, has been associated with in vivo HDPA cross-reactivity of four of 33 (12%) (38).…”

Comparative effectiveness and safety of anticoagulants for the treatment of heparin‐induced thrombocytopenia

“…Of these, 309 were excluded because no new data were given ( n = 130), insufficient clinical data reported ( n = 44), double publication ( n = 81), case reports only ( n = 9), or used an investigational therapy other than one of the pre‐specified anticoagulants ( n = 45). Ninety‐two articles reporting on 4698 patients in 119 study groups were eventually included 20‐111 . A flow‐diagram of the articles is illustrated in Figure 1.…”

Minimizing the incidence of heparin‐induced thrombocytopenia: to heparinize or not to heparinize vascular access?

“…Heparin‐induced thrombocytopenia (HIT) is an immune‐mediated hematological condition that can result in significant morbidity and mortality because of paradoxical thromboembolism termed heparin‐induced thrombocytopenia and thrombosis (HITT). In the pediatric population, the occurrence of this disease entity was once thought to be a rare phenomenon with only case reports described in the medical literature (2–9). In recent years, however, a number of large‐scale studies have revealed that the true incidence of HIT in pediatric patients is 1–3% (10–13), which is actually similar to that of adult patients (1,14,15).…”