[Heparin induced thrombocytopenia. A frequently unrecognised complication after major orthopedic surgery].
The application of unfractioned (UFH) and low molecular weight heparins (LMH) has reduced the incidence of thromboembolic events. However, the frequency of heparin-induced thrombocytopenia (HIT II) in orthopedic patients, particularly susceptible for both thromboembolic complications and HIT II with potentially life threatening complications, is about 0.5% for LMW and 3% UFH. Induced by an immune response, the excessive activation of platelets and endothelial cells causes massive thrombin generation and, as a result, thrombotic vessel occlusion. The rates of mortality and amputation in HIT II are estimated to be 30% and 20%, respectively. The clinical course is highly dependent on early therapeutic intervention, consisting of compatible and adequately dosed anticoagulation drugs. Vitamin K antagonists as well as platelet substitution may lead to disastrous sequelae. We summarize the current state of the pathophysiology, diagnosis and therapy of HIT II and illustrate therapeutic mistakes in a case report.
Picker
S M
SM
Transfusionsmedizin der Universität zu Köln. susanne.picker@medizin.uni-koeln.de
Gathof
B S
BS
D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects*; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D006493:Heparin / Q000008:administration & dosage / Q000009:adverse effects*; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D009985:Orthopedics; D015207:Osteoarthritis, Hip / Q000601:surgery*; D011183:Postoperative Complications / Q000175:diagnosis; D012307:Risk Factors; D013921:Thrombocytopenia / Q000139:chemically induced* / Q000175:diagnosis / Q000276:immunology; D013923:Thromboembolism / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology*; D013924:Thrombophlebitis / Q000188:drug therapy / Q000601:surgery; D013997:Time Factors
D000925:Anticoagulants; D005343:Fibrinolytic Agents; D006495:Heparin, Low-Molecular-Weight; D006493:Heparin