[Current recommendations for diagnosis and therapy of heparin-induced thrombocytopenia].
Thrombosis prophylaxis using heparins is mandatory in most trauma patients. However, heparins can induce heparin-induced thrombocytopenia (HIT), the most common and clinically important immune-mediated drug-dependent thrombocytopenia. Affected patients are at risk of developing new thromboembolic complications. HIT has to be considered if platelet counts decrease >50% between day 5-10 of heparin therapy that cannot be explained alternatively or if new thromboses occur in a sufficiently heparinised patient. Immediately changing the anticoagulant to danaparoid or lepirudin is most important. Proof of anti-platelet-factor-4/heparin antibodies secures the diagnosis, usually retrospectively. Diagnosis and therapy are demonstrated in a typical HIT patient. HIT usually occurs in the second week of heparin administration. Heparin-reexposure within 100 days can lead to HIT before day 5. For early recognition of HIT, platelet counts should be monitored regularly. Because of earlier discharge of patients to rehabilitation or outpatient care, the problem of HIT-diagnosis and therapy gains increasing relevance in these sectors.
Hinz
P
P
Abteilung für Unfall- und Wiederherstellungschirurgie, Ernst-Moritz-Arndt-Universität, Greifswald, Germany.
Lubenow
N
N
Eckernkamp
A
A
Geinacher
A
A
D000328:Adult; D000925:Anticoagulants / Q000008:administration & dosage; D001323:Autoantibodies / Q000097:blood; D002809:Chondroitin Sulfates / Q000008:administration & dosage; D003871:Dermatan Sulfate / Q000008:administration & dosage; D004338:Drug Combinations; D050723:Fractures, Bone / Q000601:surgery*; D006493:Heparin / Q000008:administration & dosage / Q000009:adverse effects*; D006497:Heparan Sulfate / Q000008:administration & dosage; D006629:Hirudins / Q000008:administration & dosage / Q000031:analogs & derivatives*; D006801:Humans; D008297:Male; D009104:Multiple Trauma / Q000601:surgery*; D010976:Platelet Count; D010978:Platelet Factor 4 / Q000276:immunology; D011183:Postoperative Complications / Q000517:prevention & control*; D011994:Recombinant Proteins / Q000008:administration & dosage; D013921:Thrombocytopenia / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy; D013923:Thromboembolism / Q000139:chemically induced / Q000517:prevention & control*
D000925:Anticoagulants; D001323:Autoantibodies; D002809:Chondroitin Sulfates; D003871:Dermatan Sulfate; D004338:Drug Combinations; D006493:Heparin; D006497:Heparan Sulfate; D006629:Hirudins; D010978:Platelet Factor 4; D011994:Recombinant Proteins; C035838:danaparoid; C083544:lepirudin