On the prophylactic and therapeutic use of danaparoid sodium (Orgaran) in patients with heparin-induced thrombocytopenia.
Heparin-induced thrombocytopenia (HIT) is a rare but dangerous complication of heparin prophylaxis or treatment. The present laboratory tests to measure heparin-associated antibodies are not specific. The diagnosis of HIT mainly depends on the decrease in platelet count and on clinical symptoms. To evaluate clinical outcome, bleeding complications and platelet counts were evaluated in 45 patients with HIT type II (HIT II) treated prophylactically (subcutaneous injections) or therapeutically (intravenous infusion) with danaparoid. Group I included 24 patients with HIT II without thromboembolic complications who received danaparoid twice daily subcutaneously (10 IU/kg) for a mean of 16 days. Group II included 21 patients with thromboembolic complications. They were treated with intravenous danaparoid (2.6 IU/kg/h +/- 1.1) for a mean of 17 days. During subcutaneous prophylaxis, mean anti-Xa levels of 0.2 U/mL and during intravenous treatment, mean anti-Xa levels of 0.4 U/mL were reached. No deaths, amputations, or serious bleeding complications occurred, and no new thromboses were observed in both patient groups. Treatment with danaparoid led to a fast normalization of the platelet counts. This normalization occurred earlier and the concentration of platelets was higher in patients treated with intravenous doses. Danaparoid with subsequent vitamin K-antagonist treatment effectively prevents thromboembolic complications in patients with HIT.
Schenk
Joachim F
JF
Department of Clinical Hemostaseology and Transfusion Medicine, University of Saarland, Homburg/S, Germany. htjfsc@uniklinik-saarland.de
Pindur
Gerhard
G
Stephan
Bernhard
B
Mörsdorf
Stephan
S
Mertzlufft
Friedrich
F
Kroll
Hartmut
H
Wenzel
Ernst
E
Seyfert
Ulrich T
UT
D000925:Anticoagulants / Q000627:therapeutic use*; D002809:Chondroitin Sulfates / Q000008:administration & dosage / Q000627:therapeutic use*; D003871:Dermatan Sulfate / Q000008:administration & dosage / Q000627:therapeutic use*; D004338:Drug Combinations; D005260:Female; D006493:Heparin / Q000009:adverse effects*; D006497:Heparan Sulfate / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007279:Injections, Subcutaneous; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D010976:Platelet Count; D010978:Platelet Factor 4 / Q000032:analysis; D013921:Thrombocytopenia / Q000139:chemically induced* / Q000517:prevention & control*; D016896:Treatment Outcome
D000925:Anticoagulants; D002809:Chondroitin Sulfates; D003871:Dermatan Sulfate; D004338:Drug Combinations; D006493:Heparin; D006497:Heparan Sulfate; D010978:Platelet Factor 4; C035838:danaparoid