Danaparoid cross-reactivity with heparin-induced thrombocytopenia antibodies: report of 12 cases.
OBJECTIVE
Danaparoid is a safe and effective drug for the treatment of heparin-induced thrombocytopenia (HIT). We describe an uncommon complication: danaparoid cross-reactivity with HIT antibodies.


METHODS
A retrospective observational multicenter study on HIT was conducted in France. In this study concerning HIT patients treated with lepirudin, 12 patients were treated with lepirudin because danaparoid cross-reacted with the heparin-dependent antibodies.


RESULTS
Three groups of situations can be separated. In a first group, four patients received a short course of danaparoid until their initial functional HIT assay showed a cross-reactivity between danaparoid and HIT antibodies. One patient presented a fatal thrombotic complication but the relationship between this thrombotic complication and danaparoid cross-reactivity cannot be certain. In a second group, four patients received for 4 days at least a danaparoid treatment while the initial functional test did not show any danaparoid cross-reactivity. During danaparoid treatment, no significant increase of platelet count was observed and two patients presented a fatal thrombotic complication. In a third group, cross-reactivity between danaparoid and HIT antibodies was not checked before danaparoid therapy. During danaparoid treatment, no significant increase of platelet count was observed and the four patients developed a venous thromboembolic complication.


CONCLUSIONS
Absence of any increase in platelet count after 3 to 5 days of danaparoid therapy and/or the occurrence of a new thrombotic event should lead to danaparoid cross-reactivity suspicion. However, before attributing thrombotic complications to danaparoid cross-reactivity, it is crucial to verify that the patients received the recommended danaparoid dosage regimen.
Hemostasis Department, EA 3065, CHRU, Saint-Etienne 42055, France. brigitte.tardy@chu-st-etienne.fr
B
B
Tardy-Poncet
M
M
Wolf
D
D
Lasne
A
A
Bauters
P
P
Ffrench
I
I
Elalamy
B
B
Tardy
D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use; D002809:Chondroitin Sulfates / Q000008:administration & dosage / Q000494:pharmacology* / Q000627:therapeutic use; D003429:Cross Reactions; D003871:Dermatan Sulfate / Q000008:administration & dosage / Q000494:pharmacology* / Q000627:therapeutic use; D005260:Female; D006487:Hemostasis / Q000187:drug effects; D006493:Heparin / Q000008:administration & dosage / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use; D006497:Heparan Sulfate / Q000008:administration & dosage / Q000494:pharmacology* / Q000627:therapeutic use; D006629:Hirudins; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000139:chemically induced* / Q000276:immunology; D011994:Recombinant Proteins / Q000627:therapeutic use; D012189:Retrospective Studies
D000925:Anticoagulants; D002809:Chondroitin Sulfates; D003871:Dermatan Sulfate; D006493:Heparin; D006497:Heparan Sulfate; D006629:Hirudins; D011994:Recombinant Proteins; C035838:danaparoid; C083544:lepirudin