Delayed-Onset Heparin-Induced Thrombocytopenia

Rice, Lawrence; Attisha, Walid K.; Drexler, Alane; Francis, John L.

doi:10.7326/0003-4819-136-3-200202050-00009

Cited by 248 publications

(176 citation statements)

References 19 publications

Supporting

Mentioning

172

Contrasting

Order By: Relevance

“…Nearly all patients with ''acuteonset'' HIT had been given heparin within the previous 3 weeks [11]. It is not universally recognized that HIT, often accompanied by thrombosis, can occur for the first time up to 4, and perhaps even 6, weeks after heparin has been discontinued and that readministration of heparin can have catastrophic consequences for these individuals [15,16]. The clinical courses of patients with ''typical,'' ''acute,'' and ''delayed'' HIT are illustrated in Fig.…”

Section: Clinical Features Of Hit Heparin Exposurementioning

confidence: 99%

See 1 more Smart Citation

Heparin‐induced thrombocytopenia and thrombosis

Davoren

Aster

2005

American J Hematol

View full text Add to dashboard Cite

Heparin, employed clinically for more than 50 years, is still a widely used anticoagulant. Unfortunately, some patients given this agent develop thrombocytopenia and thrombosis. Because this side effect can have catastrophic consequences, it is imperative that all clinicians caring for patients who receive heparin have at least a basic understanding of its pathogenesis, diagnosis, and management. Am. J. Hematol. 81:36-44, 2006Hematol. 81:36-44, . ª 2005 Wiley-Liss, Inc.

show abstract

Section: Clinical Features Of Hit Heparin Exposurementioning

confidence: 99%

“…''Delayed HIT,'' which can occur 1-4 weeks after heparin has been stopped, can be associated with lifethreatening thrombosis [15,16]. It is essential that a solid-phase ELISA test be done in any patient suspected of having delayed HIT before heparin therapy is initiated.…”

Section: Clinical Diagnosismentioning

confidence: 99%

Heparin‐induced thrombocytopenia and thrombosis

Davoren

Aster

2005

American J Hematol

View full text Add to dashboard Cite

show abstract

“…Despite recognition, adequate therapies are very limited with a high risk of death, of about 20 percent. 2,3 …”

Section: Resultsmentioning

confidence: 99%

“…Most common complications are venous thromboembolism or thrombosis of arteries or arterial grafts. 2,3 Our patient presented a microangiopathy with partial thrombosis of the abdominal aorta and both iliac arteries and ischemic pain of the lower limbs. He also developed this condition much later after heparin administration.…”

Section: Discussionmentioning

confidence: 99%

Wound Necrosis and Peripheral Microangiopathy due to Delayed-onset Heparin-induced Thrombocytopenia Following Arterial Bypass Surgery

Herren

Haller

2012

EJVES Extra

View full text Add to dashboard Cite

a b s t r a c tIntroduction: Delayed-onset heparin-induced thrombocytopenia (HIT) is a rare side effect of heparin. This prothrombotic condition can present its first signs up to three weeks following heparin administration even if heparin use has been stopped. Report: A 54-year-old claudicant patient underwent a suprageniculate limb bypass with heparin administration. Despite bypass patency, our patient developed recurrent wound necrosis and kept complaining of ischemic pain. The patient then developed toe necrosis and underwent leg amputation. Conclusion: Delayed-onset HIT is a rare condition that should be looked for and promptly managed in patients with peripheral vasculopathy following heparin administration.Ó 2012 European Society for Vascular Surgery. Published by Elsevier Ltd. IntroductionDelayed-onset heparin-induced thrombocytopenia (HIT) is a rare side effect of heparin. In contrast to classical HIT, this prothrombotic condition can present its first signs up to three weeks following heparin administration even if heparin use has been stopped. 1 We report the case of a claudicant patient who underwent suprageniculate bypass surgery. The patient developed delayed onset HIT that caused wound dehiscence and necrosis. Despite aggressive multidisciplinary management, the patient developed distal toe and leg necrosis. ReportA 54-year-old man with a past history of diabetes mellitus type II and hypertension presented with bilateral peripheral arterial disease. He could not walk more than 200 m without calf pain (Fountain IIB), with a significant stenosis of the left superficial femoral artery and an extensive occlusion of the right superficial femoral artery. We performed a right suprageniculate femoropopliteal vein bypass as well as a percutaneous angioplasty and stent implantation of the left superficial femoral artery. Unfractionated heparin 3 500 UI was given during surgery. The initial evolution was uneventful and the patient was discharged at day 7. Postoperative angiological examination showed improved ankle plethysmography of 55 mmHg on the right and 65 mmHg on the left (35 and 50 mmHg in the preoperative setting respectively). Three weeks following hospital discharge, the patient developed bilateral limb claudication with a hanging livedo. All surgical scars of the femoro-popliteal bypass were necrotic and the 3 first toes were also cyanotic ( Figs. 1 and 2). An angiological exam showed that the left femoral artery stent was still patent as was the femoropopliteal bypass on the right. Immunological and hematological workups were done and were normal. After a multidisciplinary approach, delayed-onset HIT was suspected based on high anti-PF4 antibodies (4 times threshold values) and, retrospectively, a platelet count showed a biphasic profile with a decrease of more than 30 percent. Heparin administration was stopped and replaced by fondaparinux. The patient mostly complained of pain in both feet and legs that was difficult to control with morphine derivatives, pregabalin (Lyrica Ò ) and haloperidol (...

show abstract

“…1). However, it remains possible that the patient developed ''delayed-onset'' HIT between postoperative days 7 to 14, a transient thrombocytopenic syndrome associated with increased risk of thrombosis, including venous thromboembolism [15,16].…”

mentioning

confidence: 99%