HEPARIN-INDUCED THROMBOCYTOPENIA
Keywords:
heparin-induced thrombocytopenia, non-fractionated heparin, low molecular weight heparin, direct thrombin inhibitors, thrombotic complications
Abstract
This review considers heparin-induced thrombocytopenia (HIT) – pathological condition that can develop when applying non-fractionated heparin (NFH). Due to insufficient knowledge and absence of required laboratory tests HIT is a rarely diagnosed condition in our clinics that influences on the adequate treatment of patients and prognosis. In vitro studies demonstrated that immune processes like forming HIT-antibodies and their interaction with heparin-tissue factor-4 complex and FcγRII-receptors on the platelets is the key moment in HIT. A big disadvantage is inability to get alternative anticoagulants. Management of hemorrhage in HIT especially without antidote is problematic. Applying heparins with low molecular weight and fondaparinux and direct thrombin inhibitors instead of NFH can result in that the HIT will become only a past history event.
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References
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14. Walegna J.M. Newer insights on the mechanism of heparin-induced thrombocytopenia. / Walegna J.M., Jeske W.P., Prechel M.M., Bakhos M. // Semin Thromb Hemost. – 2004. – № 30 (Suppl). – P. 57-67.
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18. Warkentin T.E. Heparin-induced thrombocytopenia in patients treated with low-molecular-weight heparin or unfractionated heparin / Warkentin T.E., Levine M.N., Hirsh J., at al. // N. Engl. J. Med. – 1995. – № 332. – P. 1330-1335.
19. Wester J.P. Thrombosis and hemorrhage in heparin-induced thrombocytopenia in seriously ill patients / Wester J.P., Haas F.J., Biesma D.H., [et al.] // Intensive Care Med. – 2004. – № 30. – P. 1927-1934.
20. Yirsh J . Heparin and low – molecular weight heparin: mechanism of action , pharmacokinetics , dosing , monitoring , efficacy , and safety / Yirsh J., Warkentin T. E., Shaughnessy S. G. [[et al.]] // Chest. – 2001. – № 119. – P. 64 S -94 S.
2. Gilorami B. The incidence of heparin-induced thrombocytopenia in hospitalized medical patients treated with subcutaneous unfractionated heparin: a prospective cohort study/ Gilorami B., Prandoni P., Stefani P.M., et al .// Blood. – 2003. – № 101. – P. 2955-2959.
3. Greinacher A. Antigen generation in heparin-associated thrombocytopenia: the nonimmunological type and the immunological type are closely linked in their pathogenesis. // Semin Thromb Hemost. – 1995. – № 21. – P. 106-116.
4. Greinacher A. Heparin-associated thrombocytopenia: isolation of the antibody and characterization of a multimolecular PF4-heparin complex as the major antigen // Greinacher A., Potzsch B., Amiral J., [et al.] // Thromb. Haemost. – 1994. – № 71. – P. 247-51.
5. Harenberg J. Heparin-induced thrombocytopenia: pathphysiology and new treatment options / Harenberg J., Jorg I., Fenyvess T. // Pathophysiol. Haemost. Thromb. – 2002. – № 32. – P.289-294.
6. Hong A.P. Central venous catheter and upper extremity deep vein thrombosiscowplicating immune heparin-induced thrombocytopenia / Cook D.J., Sigouin C.S., Warkentin T.E. // Blood. – 203. – №101. – P.3049-3051.
7. Ling E. Intraoperative heparin flashes and subsequent acute heparin-induced thrombocytopenia // Ling E., Warkennin N.E. // Anesthesiology. – 1998. – № 89. – P.1567-1569.
8. Mar A.W. Skin necrosis following subcutaneous heparin injection // Mar A.W., Dixon D., Ibrahim K., Parkin J.D. // Australas J. Dermatol. – 1995. – № 36. – P.201-203.
9. Newman P.M. Heparin-induced thrombocytopenia: new evidence for the dynamic binding of purified anti-PF4-heparin antibodies to platelets and the resultant platelet activation / Newman P.M., Chong B.H. // Blood. – 2000. – № 96. -P. 182-187.
10. Silver D. Heparin-induced thrombocytopenia, thrombosis, and hemorrhage / Silver D., Kapsh D.N., Tsoi E.K. // Ann Surg. – 1993. – № 198. – P. 301-306.
11. Greinacher A. Heparin-associated thrombocytopenia: isolation of the antibody and haracterizationof a multimolecular PF-4-heparin complex as the major antigen / Potzsch B., Amiral J., [et al.] // Thromb. Haemost. – №71. – P.247-251.
12. Verma A.K. Frequence of heparin-induced thrombocytopenia in critical care patients / Verma A.K., Levine M., Shalansty S.J., [et al.] // Pharmacotherapy. – 2003. – № 23. – P.745-753.
13. Visentin G.P. Patients treated with unfractionated heparin during open heart surgery are at high risk to form antibodies reactive with heparin: platelet factor 4 complexes / Visentin G.P., Malic M., Cyganiak K.A., Aster R.H. // J. Lab. Clin. Med. – 1996. – № 128. – P.376-83.
14. Walegna J.M. Newer insights on the mechanism of heparin-induced thrombocytopenia. / Walegna J.M., Jeske W.P., Prechel M.M., Bakhos M. // Semin Thromb Hemost. – 2004. – № 30 (Suppl). – P. 57-67.
15. Askari A.T. Management Strategies in Antithrombotic Therapy/ Askari A.T., Messerli A.W., Lincoff A.M. – England, Wiley, 2007. – 350 p.
16. Warkentin T. E . Delayed-oncet heparin-induced thrombocytjpenia and thrombosis / Warkentin T. E ., Kelton J. G . // Ann. Intern. Med. – 2001. – № 135. – P. 502-506.
17. Warkentin T. E . Temporal aspects of heparin – induced thrombocytopenia / Warkentin T. E ., Kelton J. G // N. Eng J. Med. – 2001. – № 344. – P. 1286-1292.
18. Warkentin T.E. Heparin-induced thrombocytopenia in patients treated with low-molecular-weight heparin or unfractionated heparin / Warkentin T.E., Levine M.N., Hirsh J., at al. // N. Engl. J. Med. – 1995. – № 332. – P. 1330-1335.
19. Wester J.P. Thrombosis and hemorrhage in heparin-induced thrombocytopenia in seriously ill patients / Wester J.P., Haas F.J., Biesma D.H., [et al.] // Intensive Care Med. – 2004. – № 30. – P. 1927-1934.
20. Yirsh J . Heparin and low – molecular weight heparin: mechanism of action , pharmacokinetics , dosing , monitoring , efficacy , and safety / Yirsh J., Warkentin T. E., Shaughnessy S. G. [[et al.]] // Chest. – 2001. – № 119. – P. 64 S -94 S.
How to Cite
Kopytsa, N., & Lytvyn, O. (1). HEPARIN-INDUCED THROMBOCYTOPENIA. The Journal of V. N. Karazin Kharkiv National University, Series "Medicine", (18), 58-64. Retrieved from https://periodicals.karazin.ua/medicine/article/view/6957
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