Heparin-Induced Thrombocytopenia

Lübenow, Norbert; Kempf, Reiner; Eichner, Angelika; Eichler, Petra; Carlsson, Lena E.; Greinacher, Andreas

doi:10.1378/chest.122.1.37

Cited by 176 publications

(21 citation statements)

References 17 publications

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“…Reviewing current literature there is no evidence of remaining HIT antibodies 2 years after the administration of LMWH. Moreover, patients who are re-exposed to LMWH usually develop “early onset thrombocytopenia” (<5 days) due to prior immune response (Linkins et al 2012 ; Lubenow et al 2002 ). This was not the case in our patient who presented with new onset of thrombocytopenia on day eight after surgery.…”

Section: Discussion and Evaluationmentioning

confidence: 99%

“…The absence of pathological findings within the patient`s medical history does not ensure that re-administration of LMWH may not result in HIT II. However, patients with heparin exposure within the last 100 days show an early onset (<5 days) of thrombocytopenia whereas if LMWH have been administered more than 3 months ago, the onset of thrombocytopenia seems to be indistinguishable from patients having had their initial exposure to heparin (typically day 5–10) (Lubenow et al 2002 ; Dasararaju et al 2013 ).…”

Section: Introductionmentioning

confidence: 99%

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Heparin-induced thrombocytopenia in a non-heparin-naive patient: a case report

et al. 2015

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IntroductionAdministration of low molecular weight heparin (LMWH) is recommended for prophylaxis of venous thromboembolism in patients undergoing hip surgery. In this context, heparin-induced thrombocytopenia (HIT) type II is a complication of rare incidence but sometimes fatal outcome.Case descriptionA 52-year old obese patient undergoing antithrombotic therapy with Enoxaparin after hip surgery presented with a painful, swollen leg and thrombocytopenia on day eight after surgery. Medical history showed previous administration of Enoxaparin without complications 2 years ago. Further diagnostic investigation supplied evidence of multiple thromboembolic events and concomitant compartment syndrome. Administration of Enoxaparin was stopped immediately and treatment with Argatroban was initiated. Diagnosis of HIT was confirmed according to current guidelines. Despite interventional thrombectomy and fasciotomy, amputation of both lower limbs had to be performed due to ongoing necroses. After a 30-days-stay at the intensive care unit because of sepsis, respiratory and renal failure, clinical condition improved and the patient could be transferred for rehabilitation.Discussion and evaluationHIT II is known as complication of administration of LMWH in the perioperative setting. Diagnosis results from clinical findings and platelet count. Argatroban is recommended as an alternative therapeutic anticoagulant in HIT II. Inflammation and surgical trauma are discussed as priming factors to increase risk of HIT II.ConclusionsAdministration of LMWH may result in HIT II despite prior uneventful drug exposure. Except for immediate diagnosis, only consequent anticoagulation can stop the course of disease. Hence, interdisciplinary awareness is inevitable for early diagnosis and accurate therapy to prevent from a catastrophic clinical course.

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Section: Discussion and Evaluationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Heparin-induced thrombocytopenia in a non-heparin-naive patient: a case report

et al. 2015

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“…In the so called 'rapid onset' HIT, thrombocytopenia occurs within 24 hours of exposure to heparin, mostly due to the presence of anti-PF4/heparin antibodies after prior exposure to heparin within the previous 100 days [15]. The onset of HIT in these cases is usually accompanied by fever, shivering, and skin lesions at the injection sites within 30 minutes after heparin administration [3].…”

Section: Clinical Manifestationsmentioning

confidence: 99%

“…Some patients also develop acute respiratory or cardiac dysfunction, manifested as hypertension, tachycardia, angina pectoris, or dyspnea. These manifestations may suggest pulmonary embolism because of the sudden pronounced platelet activation [3,15]. …”

Section: Clinical Manifestationsmentioning

confidence: 99%

Heparin-induced thrombocytopenia in the ICU: an overview

Sakr

2011

Critical Care

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“…For example, heparin's chemical heterogeneity and polydispersity lead to nonspecific protein binding, yielding poor pharmacokinetics on s.c. injection (6), and there are side effects associated with heparin therapy, including heparininduced thrombocytopenia (7,8).…”

mentioning

confidence: 99%

Rational design of low-molecular weight heparins with improved in vivo activity

Sundaram

Shriver

et al. 2003

Proc. Natl. Acad. Sci. U.S.A.

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Heparin and low-molecular weight heparins (LMWHs), complex, sulfated polysaccharides isolated from endogenous sources, are potent modulators of hemostasis. Heparin and LMWHs interact with multiple components of the coagulation cascade to inhibit the clotting process. Pharmaceutical preparations of these complex polysaccharides, typically isolated from porcine intestinal mucosa, are heterogeneous in length and composition and, hence, highly polydisperse. Because of the structural heterogeneity of heparin and LMWHs, correlating their activity with a particular structure or structural motif has been a challenging task. Herein, we demonstrate a practical analytical method that enables the measurement of a structural correlate to in vivo anticoagulant function. With this understanding we have developed LMWHs with increased anticoagulant activity and decreased polydispersity. In addition to the pronounced anti-Xa and anti-IIa activity of these LMWHs, we also demonstrate that they possess desirable in vivo pharmacokinetic properties, the ability to cause the release of tissue factor pathway inhibitor (TFPI) from the endothelium, complete bioavailability through s.c. delivery, and the ability to inhibit both venous and arterial thromboses. Importantly, from a clinical safety point of view, unlike LMWHs presently used in the clinic, we show that these LMWHs are rapidly and completely neutralized by protamine. Together, the findings presented herein demonstrate a facile approach for the creation of designer LMWHs with optimal activity profiles.

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Heparin-Induced Thrombocytopenia

Cited by 176 publications

References 17 publications

Heparin-induced thrombocytopenia in a non-heparin-naive patient: a case report

Heparin-induced thrombocytopenia in a non-heparin-naive patient: a case report

Heparin-induced thrombocytopenia in the ICU: an overview

Rational design of low-molecular weight heparins with improved in vivo activity

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