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Objective: to identify predictive factors of complications and mortality in danaparoid-treated HIT-patients. Patients and Methods: case-control study involving HIT-patients defined by a relative decrease in platelet count of over 40% with or without thrombosis at presentation and positive laboratory testing (functional assay +/− ELISA). A patient presenting a complication 48 hours after heparin replacement with danaparoid (thrombosis, DIC, amputation, haemorrhage, death) was considered as a case. Results: 49 cases and 65 controls were included (mean age 67±14 y; 51% women), from cardiovascular (53%) or orthopaedic (5%) surgery, intensive care (6%) or medicine (8%) units. Mean duration to complication was 7 days (D): death (n=26); thromboses (n=23); DIC (n=6); amputations (n=4); and haemorrhages (n=8). In univaried analysis, compared to controls, cases presented: an earlier HIT (7.9±3.5 versus 10.1±7.1 D; p=0.03) a lower platelet nadir (53±37 versus 70±37 G/L ; p=0.01), a more frequent thrombosis at HIT diagnosis (59% versus 32%, p=0.004), a later heparin withdrawal after HIT diagnosis (2.8 versus 1.3 d; p=0.01), a delayed heparin replacement (3.7 versus 1.9 d ; (p=0.001), an inadequate dosage of replacement therapy (44% versus 19% ; p=0.004). In multivaried analysis, predictive factors leading for poor outcome were: an initial thrombosis at HIT diagnosis (OR=3.2 [1.3–8]), a delay greater than 48 h for replacement therapy with danaparoid (OR=6.6 [2.5–17.3]), insufficient doses of danaparoid (OR=4.3 [1.5–12]). Conclusion: this study confirms the mandatory need for a prompt replacement therapy and strict adherence to recommended doses for HIT-patients.

Anti-GPIIb/IIIa associated thrombocytopenia has been reported in most large trials, but very little data is available regarding tirofiban. We report three cases of thrombocytopenia, most likely attributed to tirofiban (two moderate and one severe). For each patient, laboratory investigation has allowed us to exclude another cause of thrombocytopenia, particularly heparin-induced thrombocytopenia. Platelet count recovery could be earlier with tirofiban than with abciximab. Some suggestions are proposed for practical management of these patients with persistent thrombotic risk, who are sometimes candidates for cardiopulmonary bypass surgery. Am.