In vitro cross-reactivity of danaparoid sodium in patients with heparin-induced thrombocytopenia type II undergoing cardiovascular surgery.
OBJECTIVE
To assess the cross-reactivity of danaparoid sodium in patients undergoing cardiovascular surgery.


METHODS
Prospective investigation.


METHODS
A major European heart center and university hospital.


METHODS
81 patients who underwent cardiovascular surgery during the period between January 1998 and April 1999 and were diagnosed with heparin-induced thrombocytopenia (HIT) II.


METHODS
Testing was performed in patients who revealed a decrease in the platelet count >30% or a platelet count <100,000/microL during heparin therapy. Testing for HIT was performed by the use of the heparin-induced platelet-aggregation assay. Patients were evaluated as positive if an agglutination occurred in two of four of the 0.2 IU/mL heparin chambers. Patients were judged to be cross-reactive with danaparoid sodium when an agglutination occurred in two of four chambers that contained 0.2 IU/mL Orgaran.


RESULTS
281 patients (5.4% of the patients who underwent surgery during the period of the investigation) were tested for HIT II. Of these, 81 (1.5% of the total) gave a positive heparin-induced platelet-aggregation assay and 23 (28%) revealed a cross-reactivity with danaparoid sodium.


CONCLUSIONS
Cross-reactivity with heparin-induced platelet antibodies occurred in 28% of the patients who tested positive for heparin-platelet antibodies. In these patients, Orgaran would not have been a safe option. In patients with HIT II undergoing cardiac surgery, cross-reactivity with danaparoid sodium must be excluded before initiation of therapy with Orgaran, otherwise, or in cases of cross-reactivity, other options such as r-hirudin are preferred.
Koster
A
A
Department of Anesthesia, Deutsches Herzzentrum, Berlin, Germany. koster@DHZB.de
Meyer
O
O
Hausmann
H
H
Kuppe
H
H
Hetzer
R
R
Mertzlufft
F
F
D000925:Anticoagulants / Q000009:adverse effects* / Q000276:immunology; D001792:Blood Platelets / Q000276:immunology; D013504:Cardiovascular Surgical Procedures; D002809:Chondroitin Sulfates / Q000009:adverse effects* / Q000276:immunology; D003429:Cross Reactions; D003871:Dermatan Sulfate / Q000009:adverse effects* / Q000276:immunology; D004338:Drug Combinations; D004347:Drug Interactions; D006493:Heparin / Q000009:adverse effects* / Q000276:immunology; D006497:Heparan Sulfate / Q000009:adverse effects* / Q000276:immunology; D006801:Humans; D010974:Platelet Aggregation / Q000187:drug effects; D010976:Platelet Count; D013921:Thrombocytopenia / Q000097:blood / Q000139:chemically induced*
D000925:Anticoagulants; D002809:Chondroitin Sulfates; D003871:Dermatan Sulfate; D004338:Drug Combinations; D006493:Heparin; D006497:Heparan Sulfate; C035838:danaparoid