[Heparin-induced thrombocytopenia. Perspectives in a therapeutic dilemma].
Severe heparin-induced thrombocytopenia (HIT) is a complication of heparin treatment with a frequency of about 0.5% of the treated patients. It is attributed to an immune mechanism leading to the production of heparin-associated antibodies which bind to the platelets and cause their elimination through consumption, sometimes accompanied by thromboembolic episodes. Therapeutically HIT represents a dilemma since heparin administration must be stopped immediately, whereas anticoagulation is acutely indicated in order to avoid thrombotic complications. Two such cases with this dilemma are illustrated. The diagnosis of HIT was made using platelet aggregation studies and flow cytometry techniques for the detection of heparin-associated platelet antibodies. Therapeutically, low molecular weight heparins were administered with success. Besides the diagnostic problems other available therapeutic solutions are discussed.
Linde
N
N
Gerinnungs- und Fibrinolyselaboratorium Kantonsspital Basel.
Tsakiris
D A
DA
Vogt
A
A
Marbet
G A
GA
D000368:Aged; D005260:Female; D006493:Heparin / Q000008:administration & dosage / Q000009:adverse effects*; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000097:blood / Q000188:drug therapy*; D010644:Phenprocoumon / Q000008:administration & dosage; D010974:Platelet Aggregation / Q000187:drug effects; D010976:Platelet Count / Q000187:drug effects; D011655:Pulmonary Embolism / Q000097:blood / Q000188:drug therapy*; D013921:Thrombocytopenia / Q000097:blood / Q000139:chemically induced* / Q000188:drug therapy
D006495:Heparin, Low-Molecular-Weight; D006493:Heparin; D010644:Phenprocoumon
Heparin induzierte Thrombozytopenie. Perspektiven in einem therapeutischen Dilemma.