Heparin-induced thrombocytopenia type II in a surgical intensive care unit

Sakr, Yasser; Haetscher, Friederike; Gonsalves, Mateus Demarchi; Hoffman, Michael W.; Theis, Bernhard; Barz, Dagmar; Reinhart, Konrad; Kortgen, Andreas

doi:10.1016/j.jcrc.2011.06.016

Cited by 15 publications

(18 citation statements)

References 30 publications

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“…Our results are in agreement with this study, with a higher incidence of new thrombosis in HIT patients with initial thrombosis. Sakr et al reported thrombotic complications in 35.7 % of patients from a cohort of 88 surgical ICU patients with positive HIT antibodies treated with danaparoid or argatroban [ 27 ]. Considering that the initial mean dose of argatroban administered to our patients was low due to both high hemorrhagic and thrombotic risks, our study did not report more new thromboses.…”

Section: Discussionmentioning

confidence: 99%

“…A total of five bleeding events occurred in four patients, of which three events were adjudicated as major bleeding (15 %). In previous studies such events affected 5–20 % of patients with HIT, depending on the treatment drug and population studied [ 25 , 27 , 29 ]. Elalamy et al found an overall rate of major bleeding of 9 % in danaparoid-treated patients and Tardy et al reported 20.4 % of major bleeding events in lepirudin-treated patients [ 25 , 29 ].…”

Section: Discussionmentioning

confidence: 99%

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Argatroban in the management of heparin-induced thrombocytopenia: a multicenter clinical trial

Tardy‐Poncet

Nguyên²,

Thiranos

et al. 2015

Crit Care

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IntroductionThe aim of this study was to collect data in France in patients with heparin-induced thrombocytopenia who required parenteral anticoagulation and for whom other non-heparin anticoagulant therapies were contraindicated including patients with renal failure, cross-reactivity to danaparoid or at high hemorrhagic risk.MethodsA total of 20 patients, of mean age 72 ± 10 years, were enrolled in this open-label, multicenter clinical study. Exploratory statistical data analysis was performed with descriptive interpretation of intra-individual comparisons using simple univariate statistics.ResultsThe diagnosis of HIT was confirmed in 16 subjects by an independent scientific committee. Fourteen patients (70 %) were in an intensive care unit during the course of the study. Patients were treated with argatroban for a mean duration of 8.5 ± 6.1 days. The mean starting dose of argatroban was 0.77 ± 0.45 μg/kg/min. Platelet recovery was rapid.aPTT and anti-IIa activity assays were used to monitor the dose of argatroban. The mean baseline aPTT value was 45.0 ± 9.8 sec and increased to 78.2 ± 35.8 sec two hours after initiating argatroban. At this time mean argatroban concentration was 0.34 ± 0.16 and 0.61 ± 0.28 μg/ml using ECT and TT measurements, respectively. New and/or extended thromboses were reported in 25 % of patients and major bleedings were documented in 15 %. Six patients died due to their underlying medical condition.ConclusionConsidering its hepatic elimination and its short half-life, argatroban can be considered as a safe therapeutic option in HIT patients at high hemorrhagic risk and with renal failure, particularly in an ICU setting.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Argatroban in the management of heparin-induced thrombocytopenia: a multicenter clinical trial

Tardy‐Poncet

Nguyên²,

Thiranos

et al. 2015

Crit Care

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“…Both prevalence and incidence of HIT are reported <1% with very high mortality (1 in 3), and nadir platelet count was the only factor determining this dreadful outcome [ 1 ]. A retrospective study from CATCH registry revealed that HIT was not suspected in most of the patients despite a significant decline in platelet counts.…”

Section: Discussionmentioning

confidence: 99%

Heparin-Induced Thrombocytopenia in a Patient with Essential Thrombocythemia: A Case Based Update

Noel

Abbas

et al. 2015

Case Reports in Hematology

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Vascular thrombosis is a common clinical feature of both essential thrombocythemia (ET) and heparin-induced thrombocytopenia (HIT). The development of HIT in a patient with ET is rare and underrecognized. We report the case of a 77-year-old woman with preexisting ET, who was admitted with acute coronary syndrome, and IV heparin was started. She was exposed to unfractionated heparin (UFH) 5 days prior to this admission. Decrease in platelet count was noted, and HIT panel was sent. Heparin was discontinued. Patient developed atrial fibrillation, and Dabigatran was started. On day three, patient also developed multiple tiny cerebral infarctions and acute right popliteal DVT. On day ten of admission, HIT panel was positive, and Dabigatran was changed to Lepirudin. Two days later, Lepirudin was also discontinued because patient developed pseudoaneurysm on the right common femoral artery at the site of cardiac catheterization access. A progressive increase in the platelet count was noted after discontinuing heparin. Physicians should be aware of the coexistence of HIT and ET, accompanied challenges of the prompt diagnosis, and initiation of appropriate treatment.

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“…During ICU stay, 30–50% of patients exhibit thrombocytopenia, but only 1% of ICU patients develop HIT-II [ 26 ]. Recently, Sakr and coworkers described prevalence and incidence among surgical ICU patients of 0.82% and 0.62%, respectively, with a higher rate in cardiac surgery patients [ 6 ]. In the present study, cardiac and major abdominal surgery patients represented the group of patients with the highest rate of supposed or proven HIT-II, without significant differences among the groups.…”

Section: Discussionmentioning

confidence: 99%

“…Although heparin anticoagulation is cheap and easy to manage when using the activated clotting time (ACT), it may enhance bleeding, particularly in postoperative patients. Moreover, it poses a risk for developing heparin induced thrombocytopenia type II (HIT-II) and leads to life-threatening complications in patients with HIT-II [ 6 ]. Due to its regional application, citrate may reduce the risk for bleeding complications.…”

Section: Introductionmentioning

confidence: 99%

Anticoagulation Strategies in Venovenous Hemodialysis in Critically Ill Patients: A Five-Year Evaluation in a Surgical Intensive Care Unit

Sponholz

Bayer

Kabisch

et al. 2014

The Scientific World Journal

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Renal failure is a common complication among critically ill patients. Timing, dosage, and mode of renal replacement (RRT) are under debate, but also anticoagulation strategies and vascular access interfere with dialysis success. We present a retrospective, five-year evaluation of patients requiring RRT on a multidisciplinary 50-bed surgical intensive care unit of a university hospital with special regard to anticoagulation strategies and vascular access. Anticoagulation was preferably performed with unfractionated heparin or regional citrate application (RAC). Bleeding and suspected HIT-II were most common causes for RAC. In CVVHD mode filter life span was significantly longer under RAC compared to heparin or other anticoagulation strategies (P = 0.001). Femoral vascular access was associated with reduced filter life span (P = 0.012), especially under heparin anticoagulation (P = 0.015). Patients on RAC had higher rates of metabolic alkalosis (P = 0.001), required more transfusions (P = 0.045), and showed higher illness severity measured by SOFA scores (P = 0.001). RRT with unfractionated heparin represented the most common anticoagulation strategy in this study population. However, patients with bleeding risk and severe organ dysfunction were more likely placed on RAC. Citrate provided longer filter life spans regardless of vascular access site. Attention has to be paid to metabolic disturbances.

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Heparin-induced thrombocytopenia type II in a surgical intensive care unit

Cited by 15 publications

References 30 publications

Argatroban in the management of heparin-induced thrombocytopenia: a multicenter clinical trial

Argatroban in the management of heparin-induced thrombocytopenia: a multicenter clinical trial

Heparin-Induced Thrombocytopenia in a Patient with Essential Thrombocythemia: A Case Based Update

Anticoagulation Strategies in Venovenous Hemodialysis in Critically Ill Patients: A Five-Year Evaluation in a Surgical Intensive Care Unit

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