Heparin-induced thrombocytopenia and vascular surgery.
Heparin-induced thrombocytopenia (HIT) is of special interest to vascular surgeons as heparin is the predominant anticoagulant used before, during, and after vascular surgery. Further, the prothrombotic nature of this antibody-mediated disorder leads to a high frequency of limb ischemia due to large arterial occlusion by platelet-rich ("white") clots or because of extensive venous thrombosis involving large veins and small venules. This latter syndrome has been associated with coumarin anticoagulation of HIT-associated deep-vein thrombosis (coumarin-induced venous limb gangrene). Non-heparin anticoagulants, such as the direct thrombin inhibitors (lepirudin, argatroban), may be needed for intraoperative management of a patient with suspected acute HIT who requires vascular surgery. The transience of HIT antibodies provides a rationale for intraoperative use of heparin in a patient who has recovered from HIT and in whom HIT antibodies are no longer detectable.
Department of Pathology and Molecular Medicine, and Department of Medicine, McMaster University, and the Hamilton Regional Laboratory Medicine Program, Hamilton, Ontario, Canada. twarken@mcmaster.ca
T E
TE
Warkentin
D000208:Acute Disease; D000925:Anticoagulants / Q000009:adverse effects*; D006493:Heparin / Q000009:adverse effects*; D006801:Humans; D007511:Ischemia / Q000209:etiology; D007866:Leg / Q000098:blood supply; D011183:Postoperative Complications / Q000139:chemically induced*; D013921:Thrombocytopenia / Q000139:chemically induced*; D013997:Time Factors; D014656:Vascular Surgical Procedures
D000925:Anticoagulants; D006493:Heparin