Thrombosis and hemorrhage in heparin-induced thrombocytopenia in seriously ill patients.
OBJECTIVE
Heparin-induced thrombocytopenia (HIT) is the most common form of drug-induced immune-mediated thrombocytopenia. HIT may be aggravated by life-threatening arterial and venous thrombosis and, to a lesser extent, hemorrhagic complications. We investigated the incidence of thromboembolic and hemorrhagic complications in critically ill patients with the multiple organ dysfunction syndrome and HIT.


METHODS
Case-control study.


METHODS
A 33-bed general intensive care unit in a university-affiliated teaching hospital.


METHODS
Twenty consecutive patients with laboratory-proven HIT compared with 20 contemporary, consecutive patients without HIT.


METHODS
Unfractionated heparin or low-molecular-weight heparin were replaced by danaparoid sodium in patients with HIT.


RESULTS
Heparin-induced thrombocytopenia was proven by a positive platelet aggregation test. The HIT group consisted of 14 males and 6 females aged 65.2+/-10.8 years (mean +/- standard deviation) with APACHE II scores of 26.7+/-5.4. Thrombocytopenia less than 100 x 10(9)/l developed within 6.4+/-7.0 days. In 12 patients thrombocytopenia resolved after discontinuation of unfractionated heparin in 8.8+/-6.4 days. Arterial and venous thromboembolic complications occurred more frequently in HIT patients than in non-HIT patients (10/20 (50%) versus 0/20 (0%); chi-square p<0.001). Hemorrhagic complications also occurred more frequently in HIT patients than in non-HIT patients (17/20 (85%) versus 7/20 (35%); chi-square p=0.001).


CONCLUSIONS
In critically ill patients with HIT, the incidence of thromboembolic complications and hemorrhagic complications was remarkably high.
Wester
Jos P J
JP
Division of Intensive Care Medicine, Department of Internal Medicine, St. Antonius Hospital, PO Box 2500, 3430 EM Nieuwegein, The Netherlands. j.p.j.wester@olvg.nl
Haas
Fred J L M
FJ
Biesma
Douwe H
DH
Leusink
J A
JA
Veth
Gerda
G
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects* / Q000627:therapeutic use; D016022:Case-Control Studies; D002809:Chondroitin Sulfates / Q000627:therapeutic use; D016638:Critical Illness; D003871:Dermatan Sulfate / Q000627:therapeutic use; D004338:Drug Combinations; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced*; D006493:Heparin / Q000009:adverse effects*; D006497:Heparan Sulfate / Q000627:therapeutic use; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000150:complications; D012307:Risk Factors; D013921:Thrombocytopenia / Q000139:chemically induced* / Q000150:complications; D020246:Venous Thrombosis / Q000139:chemically induced*
D000925:Anticoagulants; D002809:Chondroitin Sulfates; D003871:Dermatan Sulfate; D004338:Drug Combinations; D006493:Heparin; D006497:Heparan Sulfate; C035838:danaparoid