[Ischemic vascular complications following thrombopenia induced by heparin. Diagnostic and therapeutic problems].
The authors report 21 cases of heparin-induced thrombocytopenia with ischemic vascular complications. The clinical presentations were peripheral arterial ischemia (16 cases), hemiplegia (1 case) and deep vein thrombosis (4 cases). The vascular surgeon confronted by these complications in an emergency situation should recognise the difficulties of clinical diagnosis (atypical forms) and biological investigations (problems of tests of platelet aggregation). Arterial occlusions are usually accessible to disobliteration with a Fogarty catheter without peroperative heparinisation. Delayed diagnosis explains the seriousness of these complications; in our series of 21 patients, there were 2 deaths, 1 paraplegia, 4 amputations due to arterial problems, 4 severe post-deep vein thrombosis conditions, two of which followed trans-metatarsal amputation. The diagnosis of heparin-induced thrombocytopenia implies immediate withdrawal of heparin therapy. A relay with a low molecular weight heparin is not without risk and should only be undertaken after a negative platelet aggregation test (with the low molecular weight heparin). These tests are rarely practicable in emergency situations and a relay using oral anti-vitamin K antagonists with a rapid onset of action is probably the safest option.
Obadia
J F
JF
Service de chirurgie cardiovasculaire et angiologie, hôpital du Bocage, université de Bourgogne, Dijon.
Becker
F
F
Sgro
C
C
Morelon
P
P
Lancon
J P
JP
Lorcerie
B
B
Raoux
M H
MH
Brenot
R
R
David
M
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001011:Aorta; D001012:Aorta, Abdominal; D001132:Arm / Q000098:blood supply; D004630:Emergencies; D005260:Female; D005263:Femoral Artery; D006493:Heparin / Q000009:adverse effects*; D006801:Humans; D007511:Ischemia / Q000209:etiology* / Q000601:surgery; D007866:Leg / Q000098:blood supply; D008297:Male; D008875:Middle Aged; D010689:Phlebitis / Q000209:etiology; D013921:Thrombocytopenia / Q000139:chemically induced* / Q000601:surgery / Q000628:therapy
D006493:Heparin
Complications vasculaires ischémiques secondaires aux thrombopénies induites par l'héparine. Problèmes diagnostiques et thérapeutiques.