Successful use of Arixtra® in a patient with paroxysmal nocturnal hemoglobinuria, Budd–Chiari syndrome and heparin-induced thrombocytopenia

Thrombolytic therapy is effective in paroxysmal nocturnal hemoglobinuria: a series of nine patients and a review of the literature

“…Indeed, HITT has been reported occasionally in patients with PNH. 10,16,35 We observed this complication in four out of our series of nine cases, far in excess of what one might have expected from chance alone. We have not had instances of HITT in patients who did not receive thrombolytic therapy: the most likely explanation is that such patients rarely received heparin.…”

“…1,3,4,8 However, three developments have the potential to alleviate the weight of thrombosis on disease outcome: (i) primary prevention with warfarin, 2 (ii) anti-complement therapy, 9 and (iii) thrombolytic therapy with plasminogen activators. 7,[10][11][12][13][14][15][16][17][18][19] The first two measures have been discussed elsewhere; 2,20 here we focus on the third development, by presenting nine case histories and by reviewing the literature on 15 previously published cases.…”

“…These agents also have a role in patients who have had arterial cerebral vascular accidents, 21,22 in patients who are in hemodynamic shock from pulmonary emboli, and in patients with venous thrombosis at other sites. [23][24][25][26][27][28]29,30 As for PNH, there have been a number of papers in the literature, [10][11][12][13][14][15][17][18][19]31,32 most of them on isolated cases. Here we report our experience with thrombolytic therapy in a highly selected group of nine patients with PNH, all of whom had severe thrombotic complications, which were regarded as potentially fatal if not treated, or which were progressing despite anticoagulation: in this respect, tissue plasminogen activator (tPA) can be regarded as a second-line treatment for patients with PNH complicated by venous thrombosis.…”

Effect of fondaparinux on platelet activation in the presence of heparin-dependent antibodies: a blinded comparative multicenter study with unfractionated heparin

“…[4][5][6][7][8][9] Moreover, some cases have been reported of successful treatment with fondaparinux in patients hypersensitive to heparin and lowmolecular-weight heparin. 33,34 In contrast, orthopedic patients treated with unfractionated heparin have about a 5% risk of HIT with at least half of the affected patients developing HIT-associated thrombosis; the HIT risk with low-molecular-weight heparins in this setting has been estimated as 0.75%. 1 The inability of fondaparinux to induce platelet activation in the presence of HIT sera was demonstrated in previous smaller studies.…”

Nowe spojrzenie na nocną napadową hemoglobinurię

“…Istnieją jednak doniesienia o zwiększonym ryzyku rozwoju trombocytopenii indukowanej heparyną (HIT, heparin--induced trombocytopenia) ze względu na zwiększo-ne uwalnianie czynnika tkankowego 4 (PF4, platelet factor 4) z aktywowanych PLT pacjentów z PNH, co powoduje, że stosowanie heparyny w profilaktyce jest ograniczone do sytuacji szczególnych, na przykład okresu ciąży [5,75]. W przypadku rozwoju HIT zaleca się fondaparynuks [76]. Nie ma opublikowanych badań dotyczących stosowania w PNH profilaktyki lekami przeciwpłytkowymi (np.…”