[Management of a suspicion of heparin-induced thrombopenia].
A COMPLEX SITUATION: During the acute phase of heparin-induced thrombocytopenia, the question must be raised as to whether an antithrombotic therapy is to be continued using a compound other than heparin. Later the risk of reintroducing heparin again can be discussed. THERAPEUTIC PROPOSITIONS: Excepting vena cava interruption, surgical revascularization and thrombolysis, possible therapeutic propositions can be divided into two categories; anticoagulants and related compounds (hirudin); and oral anticoagulants (anti-vitamin K) and antiplatelet agents (aspirin for example). Low molecular-weight heparin cannot be recommended in 1998 in patients with heparin-induced thrombocytopenia due to standard heparin.


CONCLUSIONS
Unfractionated heparin or low-molecular weight heparin must be stopped immediately. The hematology laboratory should be consulted. It must be remembered that prevention, based on a careful assessment of the benefit/risk ratio when initiating heparin therapy, is essential.
Département d'Anesthésie-Réanimation, Groupe Hospitalier Pitié-Salpêtrière, Paris. cmSamama.pitie@invivo.edu
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Samama
D000925:Anticoagulants / Q000009:adverse effects*; D001241:Aspirin / Q000627:therapeutic use; D006493:Heparin / Q000009:adverse effects*; D024764:Hirudin Therapy; D006801:Humans; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D012307:Risk Factors; D013921:Thrombocytopenia / Q000139:chemically induced* / Q000628:therapy*
D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D006493:Heparin; D001241:Aspirin
Conduite è tenir devant une suspicion de thrombopénie induite par héparine.