Heparin-induced thrombocytopenia with thrombotic sequelae: a review.
Heparin-induced thrombocytopenia (HIT) occurs in 1-5% of patients treated with heparin. The pathogenesis involves the formation of antibodies to heparin-platelet factor 4 complexes, and the major clinical sequelae are thrombotic. Diagnosis is based on a combination of clinical and laboratory data. Treatment consists of stopping heparin, but, insofar as the risk of thrombosis remains high, treatment by alternative antithrombotic agents is indicated. Most clinical experience has been with danaparoid sodium and hirudin. The use of low-molecular-weight heparins (LMWH) in subsequent HIT episodes has been described, but is not recommended, especially with the introduction of new agents, such as oral thrombin inhibitors and pentasaccharides, which are hoped to reduce the use of heparins and the occurrence of HIT.
Goor
Yoav
Y
Department of Internal Medicine 6, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, 6 Weizman Street, Tel-Aviv, 64239 Israel. goorfam@green.co.il
Goor
Odelia
O
Eldor
Amiram
A
D000818:Animals; D000936:Antigen-Antibody Complex / Q000096:biosynthesis; D004195:Disease Models, Animal; D004730:Endothelium, Vascular / Q000293:injuries; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006493:Heparin / Q000009:adverse effects* / Q000276:immunology; D006801:Humans; D007249:Inflammation / Q000209:etiology; D007962:Leukocytes / Q000276:immunology; D015539:Platelet Activation; D010978:Platelet Factor 4 / Q000276:immunology; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000188:drug therapy / Q000209:etiology* / Q000628:therapy; D013927:Thrombosis / Q000209:etiology
D000936:Antigen-Antibody Complex; D005343:Fibrinolytic Agents; D010978:Platelet Factor 4; D006493:Heparin