Plasmapheresis in the management of heparin-associated thrombocytopenia with thrombosis.
Heparin-associated thrombocytopenia with thrombosis (HATT) is fatal in 29% and leads to limb amputation in another 21% of patients. Patients with arterial thrombosis do worse than do those with venous thrombosis alone. Heparin-associated thrombocytopenia is mediated through IgG or IgM immunoglobulin fractions and is believed to be an immune phenomenon, with heparin acting as a hapten. In addition, endothelial injury may be responsible for the development of thrombosis. Heparin-induced platelet aggregation persists for weeks to months after its withdrawal in these patients. Acute management of HATT includes surgical thrombectomy, thrombolytic therapy, dextran, ancrod, low-molecular-weight heparin, and antiplatelet agents, but overall results remain unsatisfactory. We report the use of plasmapheresis, along with aspirin and dextran, in a patient with HATT. The patient experienced pain relief in 1 day; the heparin-associated platelet aggregation test became negative in 5 days, and there was functional salvage of the affected limb. We suggest that plasmapheresis may be an effective therapy in the management of HATT.
Nand
S
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Department of Medicine, Loyola University Stritch School of Medicine, Maywood, Illinois.
Robinson
J A
JA
D000671:Amputation, Surgical; D001241:Aspirin / Q000627:therapeutic use; D003911:Dextrans / Q000627:therapeutic use; D005260:Female; D006493:Heparin / Q000009:adverse effects*; D006801:Humans; D007383:Intermittent Claudication / Q000601:surgery; D007511:Ischemia / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D007866:Leg / Q000098:blood supply; D008875:Middle Aged; D010146:Pain; D010956:Plasmapheresis; D011183:Postoperative Complications; D013921:Thrombocytopenia / Q000139:chemically induced* / Q000628:therapy; D013927:Thrombosis / Q000139:chemically induced* / Q000628:therapy; D013997:Time Factors
D003911:Dextrans; D006493:Heparin; D001241:Aspirin