Orgaran in Heparin-lnduced Thrombocytopenia

Abstract

Patients who develop heparin-induced thrombocytopenia (HIT) frequently need further anticoagulation to treat an ongoing thromboembolic problem or to prevent one. Orgaran (Org 10172), a low-molecular-weight (LMW) glycosaminoglycuronan, has shown a low frequency (10%) of cross-reactivity in vitro with sera containing the HIT antibody, in contrast to the much higher frequency of cross-reactivity (≈ 80%) shown by the LMW heparins. This paper summarises the results of intravenous or subcutaneous Orgaran treatment in 57 of 67 Australian patients, in whom the diagnosis of HIT was reasonably confirmed by exclusion of other causes of thrombocytopenia and by objective tests. The presenting indications for Orgaran were: continuous venovenous haemofiltration and haemodialysis (n = 21), thrombo-embolism treatment (n = 23), thrombo-embolism prophylaxis (n = 10), and anticoagulation for coronary artery by-pass graft (n = 4), peripheral by-pass graft surgery and plasmapheresis (n = 1 each). The results showed Orgaran to be a safe, well-tolerated, effective (successful treatment in over 90% of patients) anticoagulant in patients with a high thrombotic and/or bleeding risk even if critically ill and requiring haemofiltration. The complete results of the world-wide study in 161 patients confirmed not only these clinical findings in the subgroup of 57 Australian patients, but also the low cross-reactivity (12 %) of Orgaran with the HIT serum factor.

Heparin‐induced thrombocytopenia (HIT) due to heparin flushes: a report of three cases

“…Two days after insertion of the catheter, the patient received her first dose of chemotherapy, which included cisplatin, paclitaxel, and cyclophosphamide. Eight days later her platelet count had fallen from 228 000 mL 21 to 111 000 mL 21 but returned to baseline within 11 days. On admission to the hospital the patient's platelet count was 256 000 mL 21 .…”

“…Eight days later her platelet count had fallen from 228 000 mL 21 to 111 000 mL 21 but returned to baseline within 11 days. On admission to the hospital the patient's platelet count was 256 000 mL 21 . Venography showed total obstruction of a short segment of the right subclavian vein proximal to the junction of the internal jugular vein, and the patient began a therapeutic dose of intravenous porcine heparin (25000 U day 21 ).…”

“…On admission her platelet count was 209 000 mL 21 . A double lumen Hickman (Davol Inc., Cranston, RI) catheter was inserted on hospital day 2 (BEES SGMLFig.…”

“…Subsequently the platelet count began rising immediately. The patient was discharged on day 15 with a platelet count of 124 000 mL 21 .…”

“…The catheter had been inserted 22 days prior to her admission and had been flushed daily with 2 mL of heparinized (porcine) saline (100 U mL 21 ) at least once a day (BEES SGMLFig. .2).…”