Heparininduzierte Thrombocytopenie Typ II

Abstract

Heparin-induced thrombocytopenia type II (HIT type II) is an immunoglobulin-mediated, drug-induced side effect for heparin-treated patients with thromboembolic complications. With an incidence of 1-3 %, mortality of 20 % it and permanent disability for another 20 % is a clinically relevant disorder. With heparin treatment or prophylaxis frequent platelet count monitoring is necessary. With HIT type II the thrombocytopenia is often a harbinger of thromboembolic complications in the venous or arterial system. If HIT type II is suspected, further heparin exposure is to be stopped immediately and another anticoagulant therapy should be started. The two anticoagulant options in Germany are discussed. At the same time the diagnosis should be confirmed by laboratory testing, including testing for cross-reactivity with danaparoid. Further therapy depends on the symptoms. In the case of clinical relevance of this disorder we should think about prophylaxis: strict indications for perioperative prophylaxis only use of low-molecular-weight heparin (LMWH) for routine prophylaxis, use of LMWH for thrombosis treatment and early change to cumarine.

Heparininduzierte Thrombo-zytopenie Typ II als Ursache eines schweren Rezidivs einer Lungenembolie

“…Die HIT II stellt mit einer Inzidenz von 0,5 ± 3 % eine seltene, jedoch potenziell lebensgefährliche Komplikation unter Heparintherapie dar [1,3,4]. Sie tritt typischerweise 5 ± 14 Tage nach Beginn der Heparingabe auf, selten erst nach der 3.…”

Blutungskomplikationen bei der Varizenchirurgie

“…Die optimale Dauer einer NMH-Prophylaxe ist bisher nicht schlüssig geklärt (10,12,18,19), so fand Hagmüller (11) wie auch wir thromboembolische Komplikationen Tage bis Wochen nach Varizenoperationen. Wenn man nun die Dauer der NMH-Prophylaxe verlängert (2), muß man aber auch mit der Zunahme der heparinassoziierten Komplikationen (7,8,16,21) rechnen. Wir sind der Ansicht, daß zumindest bei Patienten ohne besonderes Thromboserisiko auf eine zusätzliche medikamentöse Thromboseprophylaxe mit NMH in der Varizenchirurgie verzichtet werden kann (15).…”

Can a coated Dacron vascular graft maintain a heparin-induced thrombocytopenia type II?

“…For several years, in addition to frequent bleeding, immunologically related heparin-induced thrombocytopenia (HIT type II) has become increasingly important as a severe complication. There is a lack of prospective studies, but the incidence has been reported to range from 0.9% to 3.3% [1,2,3,4,5]. It is because of both the degree of sulfation and the molecular weight that the occurrence of HIT has been more frequent with UFH than with the low-molecularweight heparins (LMWH; 7.8% versus 2.2%, of which symptomatic cases have been reported at 2.7% versus 0% [6,7]).…”