Heparin-induced thrombocytopenia (an overview)

Daneschvar, Homayoun L.; Daw, H.

doi:10.1111/j.1742-1241.2006.00874.x

Cited by 19 publications

(11 citation statements)

References 68 publications

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“…12 One patient from the heparin group had a thin postoperative subdural hematoma that was diagnosed immediately after surgery on a postoperative CT scan. The heparin protocol was started at 12 hours despite this collection.…”

Section: Resultsmentioning

confidence: 99%

“…However, the absence of HIT, DVT, and hemorrhagic complications in the present series must be viewed with caution. The risk of HIT generally is low, with an incidence of approximately 3% associated with infusion of an anticoagulating dose, 12 and of 1.4%–5.2% associated the dose used for DVT prophylaxis. 34 The incidence of DVT in aSAH is 18%.…”

Section: Discussionmentioning

confidence: 99%

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Low-dose intravenous heparin infusion in patients with aneurysmal subarachnoid hemorrhage: a preliminary assessment

Simard¹,

Aldrich²,

Schreibman

et al. 2013

JNS

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Object Aneurysmal subarachnoid hemorrhage (aSAH) predisposes to delayed neurological deficits, including stroke and cognitive and neuropsychological abnormalities. Heparin is a pleiotropic drug that antagonizes many of the pathophysiological mechanisms implicated in secondary brain injury after aSAH. Methods The authors performed a retrospective analysis in 86 consecutive patients with Fisher Grade 3 aSAH due to rupture of a supratentorial aneurysm who presented within 36 hours and were treated by surgical clipping within 48 hours of their ictus. Forty-three patients were managed postoperatively with a low-dose intravenous heparin infusion (Maryland low-dose intravenous heparin infusion protocol: 8 U/kg/hr progressing over 36 hours to 10 U/kg/hr) beginning 12 hours after surgery and continuing until Day 14 after the ictus. Forty-three control patients received conventional subcutaneous heparin twice daily as deep vein thrombosis prophylaxis. Results Patients in the 2 groups were balanced in terms of baseline characteristics. In the heparin group, activated partial thromboplastin times were normal to mildly elevated; no clinically significant hemorrhages or instances of heparin-induced thrombocytopenia or deep vein thrombosis were encountered. In the control group, the incidence of clinical vasospasm requiring rescue therapy (induced hypertension, selective intraarterial verapamil, and angioplasty) was 20 (47%) of 43 patients, and 9 (21%) of 43 patients experienced a delayed infarct on CT scanning. In the heparin group, the incidence of clinical vasospasm requiring rescue therapy was 9% (4 of 43, p = 0.0002), and no patient suffered a delayed infarct (p = 0.003). Conclusions In patients with Fisher Grade 3 aSAH whose aneurysm is secured, postprocedure use of a low-dose intravenous heparin infusion may be safe and beneficial.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Low-dose intravenous heparin infusion in patients with aneurysmal subarachnoid hemorrhage: a preliminary assessment

Simard¹,

Aldrich²,

Schreibman

et al. 2013

JNS

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“…Contra‐intuitively, heparin can cause a dangerous thrombotic condition called heparin‐induced thrombocytopenia (HIT). In this autoimmune reaction antibodies develop against platelets [82]. Currently in development stages, synthetic oligosaccharide heparin mimetics show thrombin and FXa inhibition comparable with UFH without inducing HIT and with far fewer side effects [83].…”

Section: Serpins In Hemostasis and Fibrinolysismentioning

confidence: 99%

Serpins in thrombosis, hemostasis and fibrinolysis

Rau

Beaulieu

Huntington

et al. 2007

Journal of Thrombosis and Haemostasis

288

242

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Summary. Hemostasis and fibrinolysis, the biological processes that maintain proper blood flow, are the consequence of a complex series of cascading enzymatic reactions. Serine proteases involved in these processes are regulated by feedback loops, local cofactor molecules, and serine protease inhibitors (serpins). The delicate balance between proteolytic and inhibitory reactions in hemostasis and fibrinolysis, described by the coagulation, protein C and fibrinolytic pathways, can be disrupted, resulting in the pathological conditions of thrombosis or abnormal bleeding. Medicine capitalizes on the importance of serpins, using therapeutics to manipulate the serpin–protease reactions for the treatment and prevention of thrombosis and hemorrhage. Therefore, investigation of serpins, their cofactors, and their structure–function relationships is imperative for the development of state‐of‐the‐art pharmaceuticals for the selective fine‐tuning of hemostasis and fibrinolysis. This review describes key serpins important in the regulation of these pathways: antithrombin, heparin cofactor II, protein Z‐dependent protease inhibitor, α1‐protease inhibitor, protein C inhibitor, α2‐antiplasmin and plasminogen activator inhibitor‐1. We focus on the biological function, the important structural elements, their known non‐hemostatic roles, the pathologies related to deficiencies or dysfunction, and the therapeutic roles of specific serpins.

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“…64 The immune reaction in HIT Type II is caused by administration of heparins, either unfractionated or low molecular weight, and the resulting antibodies are directed against platelet factor 4 and heparin. The mere presence of antibodies is not suf fi cient to make the diagnosis of HIT Type II, as in some patients the existence of antibodies has no clinical consequences (Table 17.3 ).…”

Section: Heparin-induced Thrombocytopaenia (Hit)mentioning

confidence: 99%

Acute Ischaemic Stroke Agnieszka Anna Ardelt

Harrigan

Deveikis

Ardelt

2012

Handbook of Cerebrovascular Disease and Neurointerventional Technique

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This chapter focuses on acute ischaemic stroke: mechanisms, risk factors, clinical presentation, diagnostic evaluation, and treatment other than thrombolysis and thrombectomy, which are discussed in Chap. 9 . The topics are arranged alphabetically. Ischaemic stroke in paediatric patients is discussed separately in an appendix. Acute Ischaemic Stroke: Burden of DiseaseIn the United States, approximately 795,000 people suffer a stroke annually, and the vast majority of strokes are ischaemic in nature. Over 130,000 people with stroke die each year; only cardiac disease, cancer, and chronic lung diseases result in more deaths than stroke.1 Stroke leaves survivors with disabilities which have both personal and societal implications: 20-30% will need assistance with activities of daily living or walking, and the majority will be unable to return to work.

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Heparin-induced thrombocytopenia (an overview)

Cited by 19 publications

References 68 publications

Low-dose intravenous heparin infusion in patients with aneurysmal subarachnoid hemorrhage: a preliminary assessment

Low-dose intravenous heparin infusion in patients with aneurysmal subarachnoid hemorrhage: a preliminary assessment

Serpins in thrombosis, hemostasis and fibrinolysis

Acute Ischaemic Stroke Agnieszka Anna Ardelt

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