Heparin-induced thrombocytopaenia/Thrombosis: a clinico-pathological review

Dave, PA

doi:10.4314/eamj.v86i12.62906

Cited by 2 publications

(3 citation statements)

References 62 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…12 In addition, HITþ is an acquired, immune-mediated adverse drug reaction strongly associated with thromboembolic complications involving both the arterial and venous systems. 13 In our study, five subjects underwent seven reconstructions with these conditions. One subject with factor V Leiden underwent three microvascular midface reconstructions after a selfinflicted gunshot wound.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Head and Neck Microvascular Reconstruction in Hypercoagulable Patients

Nguyen

Egan

Crowe

et al. 2019

J Reconstr Microsurg

View full text Add to dashboard Cite

Background Inherited coagulopathies and previous thrombotic events are often considered relative contraindications to microvascular reconstruction. We hypothesize that with planning, head and neck microvascular reconstruction can be successfully performed in hypercoagulable individuals. Methods A retrospective review was conducted of subjects with coagulopathies or previous thrombotic events who underwent microvascular head and neck reconstruction. Outcomes studied were “flap-related complications” (arterial/venous compromise or flap loss) and “patient-related complications” (hematoma, deep venous thrombosis, pulmonary embolism, infection, stroke, or death). Results One hundred thirty-four microvascular flaps were performed in 117 subjects. Twenty-four subjects (20.5%) had a preoperative hypercoagulable condition and underwent 28 microvascular reconstructions. Twenty-three of 24 subjects had a previous thrombotic event, with five subjects identified with an inherited or acquired coagulopathy. All microvascular reconstructions were successful; however, complications occurred in 12 of 28 reconstructions (42.9%). Complications were “flap related” in four reconstructions (14.3%), “patient related” in nine reconstructions (32.1%), and both in one reconstruction (3.6%). Flap-related complications included small partial flap loss (n = 2), arterial compromise (n = 1), and venous compromise (n = 1), with all undergoing successful salvage. Patient-related complications included hematoma (n = 3), pulmonary embolism (n = 2), infection (n = 2), deep venous thrombosis (n = 1), and death (n = 1). Statistical analysis demonstrated that complications were more common in subjects with inferior vena cava filters (p = 0.06) and hematomas were associated with the use of therapeutic heparin infusion (p = 0.04). Conclusion Microvascular head and neck reconstruction can be successfully performed in hypercoagulable subjects. However, patient-related complications remain a concern in these subjects.

show abstract

Section: Discussionmentioning

confidence: 99%

Outcomes of Head and Neck Microvascular Reconstruction in Hypercoagulable Patients

Nguyen

Egan

Crowe

et al. 2019

J Reconstr Microsurg

View full text Add to dashboard Cite

show abstract

“…The incidence of venous thrombosis is about fourfold higher compared to arterial thrombosis [4, 5, 7−9, 12, 14, 15] and affects deep limb veins, caval veins, adrenal veins or results in pulmonary embolism [16][17][18]. Arterial thrombosis presents usually with acute limb ischemia (particularly in patients simultaneously receiving vitamin K antagonists), extensive myocardial infarction or cerebral stroke [18−22].…”

Section: Hit Symptomsmentioning

confidence: 99%

“…Moreover, some literature reports have described cases of extensive cardiac thrombus, visceral angina, sudden spleen rupture and necrotic dermatitis [23−27]. HIT can also develop in the form of an anaphylactic reaction, whose first symptom is usually haemodynamic failure, including sudden cardiac arrest [18,28]. Cardiac surgery patients are at the highest risk for the most disastrous effects of HITT; those patients can be expected to develop acute closure of arterial and venous vessels (in patients after coronary vessel revascularisation) or valve dysfunction (predominantly when preceded by valve implantation into the mitral position) with dramatic haemodynamic consequences, usually leading to death [29−31].…”

Section: Hit Symptomsmentioning

confidence: 99%

Małopłytkowość poheparynowa

Krzych

Nowacka²,

Knapik³

2015

Anaesthesiol Intensive Ther

View full text Add to dashboard Cite

Heparin-induced thrombocytopenia (HIT) is a clinical immune-mediated syndrome; symptoms of HIT result from the development of arterial and venous thrombosis and are correlated with the severity of the thrombocytopenia. In all patients receiving heparin preparations in intensive care units, platelet counts should be monitored every 2−3 days throughout therapy, particularly during days 4−14 when HIT is most likely to develop. The major screening tests should always involve a clinical assessment of HIT probability (4Ts or HEP scoring systems) and enzymatic immunoassays (IgG antibodies) for patients with a moderate to high risk of HIT. The full possibilities of such advanced diagnostic procedures are limited in Poland because functional tests are still not widely available. If the diagnosis is questionable, all heparin preparations should be withdrawn and an alternative method of anticoagulation instituted until HIT has been conclusively excluded. The use of new-generation anticoagulants (direct thrombin or Xa factor inhibitors) is currently considered the treatment of choice. Old-generation anticoagulants should not be administered (vitamin K antagonists) as they can aggravate thrombosis. If administered, their action should be reversed by vitamin K once HIT is confirmed. Antithrombotic therapy with "new" anticoagulants should be carried out at least until platelet counts return to the baseline values; the recommended duration of therapy is 4 weeks in patients with isolated thrombocytopenia or 4 months in those with thrombotic complications. Vitamin K antagonists should not be applied until the normal platelet count is restored (usually > 150 G L -1 ). When the therapy with vitamin K antagonists is reintroduced, "old" antagonists should be administered simultaneously with a "new" anticoagulant for at least 5 days due to an initial decrease in protein C concentration concentration, provided that the therapeutic value of INR is maintained (> 2) for at least 2 days.

show abstract

Heparin-induced thrombocytopaenia/Thrombosis: a clinico-pathological review

Cited by 2 publications

References 62 publications

Outcomes of Head and Neck Microvascular Reconstruction in Hypercoagulable Patients

Outcomes of Head and Neck Microvascular Reconstruction in Hypercoagulable Patients

Małopłytkowość poheparynowa

Contact Info

Product

Resources

About