Treatment of heparin-induced thrombocytopenia in cardiovascular patients.
Heparin-induced thrombocytopenia (HIT) is an antibody-mediated syndrome associated with heparin exposure, a falling platelet count and a high risk of thrombosis. Cardiovascular patients are at increased risk of HIT due to wide use of heparin in this population. Should HIT be suspected, heparin must be avoided in most situations, and anticoagulation with an alternative anticoagulant should be instituted. Preferred agents include the direct thrombin inhibitors argatroban and lepirudin, whilst bivalirudin or desirudin (other direct thrombin inhibitors) can be used in some situations. The indirect thrombin inhibitors, danaparoid and fondaparinux, can also be considered at times. These agents and their use in cardiac patients, including patients with acute coronary syndrome, percutaneous coronary interventions, acute ST elevation myocardial infarction or cardiac surgery, will be reviewed.
Matthai
William H
WH
Penn Presbyterian Medical Center, WS 392, Philadelphia, PA 19104, USA. william.matthai@uphs.upenn.edu
D015906:Angioplasty, Balloon, Coronary; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001120:Arginine / Q000031:analogs & derivatives; D002318:Cardiovascular Diseases / Q000188:drug therapy* / Q000628:therapy; D002809:Chondroitin Sulfates / Q000008:administration & dosage / Q000627:therapeutic use; D003871:Dermatan Sulfate / Q000008:administration & dosage / Q000627:therapeutic use; D004334:Drug Administration Schedule; D065427:Factor Xa Inhibitors; D000077425:Fondaparinux; D006493:Heparin / Q000009:adverse effects*; D006497:Heparan Sulfate / Q000008:administration & dosage / Q000627:therapeutic use; D006629:Hirudins / Q000008:administration & dosage; D006801:Humans; D010875:Pipecolic Acids / Q000008:administration & dosage / Q000627:therapeutic use; D011134:Polysaccharides / Q000008:administration & dosage / Q000627:therapeutic use; D011183:Postoperative Complications / Q000517:prevention & control; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000627:therapeutic use; D013449:Sulfonamides; D013917:Thrombin / Q000037:antagonists & inhibitors; D013921:Thrombocytopenia / Q000188:drug therapy* / Q000209:etiology
D000925:Anticoagulants; D001120:Arginine; D002809:Chondroitin Sulfates; D003871:Dermatan Sulfate; D065427:Factor Xa Inhibitors; D000077425:Fondaparinux; D006493:Heparin; D006497:Heparan Sulfate; D006629:Hirudins; D010875:Pipecolic Acids; D011134:Polysaccharides; D011994:Recombinant Proteins; D013449:Sulfonamides; D013917:Thrombin; C035838:danaparoid; C031942:argatroban; C083544:lepirudin