[Heparin-associated thrombocytopenia: successful therapy of patients after prospective selection of a compatible heparinoid with the heparin-induced platelet activation test].
Diagnosis of HAT type II and treatment of thromboembolic complications in these patients are difficult. Recently we have developed the heparin-induced platelet activation (HIPA) assay which allows a rapid confirmation of the tentative diagnosis of HAT type II. In vitro studies with sera of 25 patients revealed cross-reactivity to the LMW heparins Fragmin, Fraxiparin and Clexane whereas a LMW heparinoid, Org 10172 (Orgaran), did not. In a prospective study this heparinoid was selected for 10 HAT patients, for whom further parenteral anticoagulation was required. In 7 of these patients who received LMW heparins prior to laboratory investigations low platelet counts persisted under treatment with LMW heparins and 2 patients developed additional thromboembolic complications. Upon treatment with Org 10172 platelet counts normalized in 9 patients, in 1 patient thrombocytopenia was unrelated to parenteral anticoagulation, in 1 patient platelet count normalized after discontinuation of Org 10172. We conclude that the HIPA assay allows the laboratory diagnosis of HAT type II and the selection of a compatible heparin or heparinoid for further parenteral anticoagulation.
Greinacher
A
A
Institut für Klinische Immunologie und Transfusionsmedizin, Klinikum der Justus-Liebig-Universität Giessen, BRD.
Michels
I
I
Mueller-Eckhardt
C
C
D003429:Cross Reactions; D006493:Heparin / Q000008:administration & dosage / Q000009:adverse effects* / Q000145:classification; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage / Q000009:adverse effects*; D006496:Heparinoids / Q000008:administration & dosage* / Q000145:classification; D006801:Humans; D015539:Platelet Activation / Q000187:drug effects*; D010974:Platelet Aggregation / Q000187:drug effects; D010976:Platelet Count / Q000187:drug effects; D011446:Prospective Studies; D012701:Serotonin / Q000097:blood; D013921:Thrombocytopenia / Q000139:chemically induced* / Q000188:drug therapy
D006495:Heparin, Low-Molecular-Weight; D006496:Heparinoids; D012701:Serotonin; D006493:Heparin
Heparin-assoziierte Thrombozytopenie (HAT): Erfolgreiche Therapie von Patienten nach prospektiver Auswahl eines kompatiblen Heparinoids mit dem Heparin-induzierten Plättchenaktivierungs-(HIPA)-Test.