Heparin-Induced Thrombocytopenia Complicating Hemodialysis

Barginear, Myra F.; Donahue, Laura; Allen, Sheila; Budman, Daniel R.; Bradley, Thomas; Bhaskaran, Madhu; Shapira, Iuliana

doi:10.1177/1076029607304405

Cited by 11 publications

(4 citation statements)

References 24 publications

(23 reference statements)

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“…We identified nonrandomized studies evaluating the use of argatroban, danaparoid, fondaparinux, bivalirudin, and rivaroxaban. Ten studies reported on treatment with argatroban, [111][112][113][114][115][116][117][118][119][120] 3 studies reported on treatment with danaparoid, 70,121,122 3 studies reported on treatment with fondaparinux, [123][124][125] 2 studies reported on treatment with bivalirudin, 57,126 and 1 study reported on treatment with rivaroxaban. 127 These studies reported on the outcomes of bleeding, thromboembolic events, mortality, and serious adverse events.…”

Section: Remarkmentioning

confidence: 99%

“…Among 97 patients with HIT who received argatroban, 18 deaths were reported; however, none were the result of thrombosis. [111][112][113][114][115][116][117][118][119][120] One patient with peripheral vascular disease underwent amputation, and 3 patients developed thrombotic events. Major bleeding occurred in 3 of 50 treatment courses in 1 study and in 2 of 30 patients in another study.…”

Section: Remarkmentioning

confidence: 99%

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American Society of Hematology 2018 guidelines for management of venous thromboembolism: heparin-induced thrombocytopenia

et al. 2018

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Background: Heparin-induced thrombocytopenia (HIT) is an adverse drug reaction mediated by platelet-activating antibodies that target complexes of platelet factor 4 and heparin. Patients are at markedly increased risk of thromboembolism. Objective: These evidence-based guidelines of the American Society of Hematology (ASH) are intended to support patients, clinicians, and other health care professionals in their decisions about diagnosis and management of HIT. Methods: ASH formed a multidisciplinary guideline panel balanced to minimize potential bias from conflicts of interest. The McMaster University GRADE Centre supported the guideline development process, including updating or performing systematic evidence reviews. The panel prioritized clinical questions and outcomes according to their importance for clinicians and patients. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess evidence and make recommendations, which were subject to public comment. Results: The panel agreed on 33 recommendations. The recommendations address screening of asymptomatic patients for HIT, diagnosis and initial management of patients with suspected HIT, treatment of acute HIT, and special situations in patients with acute HIT or a history of HIT, including cardiovascular surgery, percutaneous cardiovascular intervention, renal replacement therapy, and venous thromboembolism prophylaxis. Conclusions: Strong recommendations include use of the 4Ts score rather than a gestalt approach for estimating the pretest probability of HIT and avoidance of HIT laboratory testing and empiric treatment of HIT in patients with a low-probability 4Ts score. Conditional recommendations include the choice among non-heparin anticoagulants (argatroban, bivalirudin, danaparoid, fondaparinux, direct oral anticoagulants) for treatment of acute HIT.

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Section: Remarkmentioning

confidence: 99%

Section: Remarkmentioning

confidence: 99%

American Society of Hematology 2018 guidelines for management of venous thromboembolism: heparin-induced thrombocytopenia

et al. 2018

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“…Several recent publications have reported a higher occurrence of HIT in patients treated with contaminated heparin. 25,26 The hypersulfated glycosaminoglycans such as the pentasaccharide polysulfate also produce a much higher incidence of HIT. The main contaminant in recalled heparin is identified to be oversulfated chondroitin sulfate (OSCS), 27 the same compound known to have caused several deaths due to generation of bradykinin, a potent vasoactive mediator, and generation of C3a and C5a, potent anaphylatoxins derived from complement proteins.…”

Section: Frequency Of Hitmentioning

confidence: 99%

An Update on the Prevalence and Characterization of H-PF4 Antibodies in Asian-Indian Patients

Kannan

Saxena²,

Adiguzel³

et al. 2009

Semin Thromb Hemost

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Heparin is the second most widely used anticoagulant/antithrombotic agent besides warfarin and is commonly used for various purposes such as treatment and surgical indications. A significant adverse effect of heparin treatment can occur when heparin binds platelet factor 4 (H-PF4) to form a complex that results in formation of H-PF4 antibodies, which in turn leads to platelet/endothelial cell activation followed by heparin-induced thrombocytopenia (HIT). Based on the heparin-induced platelet aggregation and enzyme-linked immunosorbent assay tests, the H-PF4 antibody (HIT antibody) was diagnosed in 6% of Indian patients undergoing cardiovascular surgery who received unfractionated heparin, but the frequency of occurrence rose to 15% when the patients were tested with the (14)C-serotonin release assay. This highlights some methodological variations in the diagnosis of HIT antibodies. It was also found that all the HIT-positive patients were either homozygous or heterozygous for the FcgammaRIIa polymorphism, which also highlights the role of this polymorphism in the occurrence of HIT. Very recent studies show that increases in HIT antibody production may also be due to heparin contaminants. Although these antibodies do not result in thrombocytopenia, contaminants in heparin may be capable of triggering a differential immunogenic response in comparison with contaminant-free heparin. Here we discuss the methodological differences in diagnosing HIT, the potential impact of contaminants in heparin, as well as future considerations.

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“…These direct factor inhibitors have a different mechanism of action than warfarin or the activation of antithrombin III by heparins. Anticoagulation of a patient with calciphylaxis with argatroban has been reported, but use of DOACs in calciphylaxis is not well described in the literature.…”

Section: Introductionmentioning

confidence: 99%