Heparin-Related Thrombocytopenia and Adrenal Hemorrhagic Necrosis Following Aortic Surgery

Leschi, J; Goëau-Brissonnière, Olivier; Coggia, Marc; Chiche, Laurent

doi:10.1007/bf02133073

Cited by 8 publications

(6 citation statements)

References 10 publications

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“…In addition to our patient, who developed acute renal failure and myocardial infarction, one patient developed acute renal failure (12), and another patient suffered a myocardial infarction (15). One patient had undiagnosed BAH and adrenal insufficiency for 2 yrs with multiple hospital admissions for nausea, vomiting, and abdominal pain (9).…”

Section: Literature Reviewmentioning

confidence: 61%

“…In the second, the diagnosis of HIT was made and treatment with ethyl biscoumacetate for anticoagulation was initiated. In this case, the patient had sudden worsening of hemodynamic status, with a failure to diagnose adrenal hemorrhage, and died shortly after transfer to the intensive care unit (12). The third mortality was without recognition of either HIT or adrenal insufficiency.…”

Section: Literature Reviewmentioning

confidence: 97%

“…There were five deaths, resulting in an overall mortality rate of 27.8%, and in three cases, where adrenal insufficiency was undiagnosed, mortality was 100% (6, 12, 14 –16). In two of the five mortalities, the diagnosis of adrenal insufficiency was made and steroid replacement initiated; however, mortality ensued on postoperative day 31 and 1 month following intensive care unit discharge, respectively (15, 16).…”

Section: Literature Reviewmentioning

confidence: 99%

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Bilateral adrenal hemorrhage: The unrecognized cause of hemodynamic collapse associated with heparin-induced thrombocytopenia*

Rosenberger

Smith

Sawyer

et al. 2011

Critical Care Medicine

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Objective-Heparin-induced thrombocytopenia is a common adverse effect of treatment with heparin resulting in paradoxical thromboses. An immunoglobulin G class "heparin-induced thrombocytopenia antibody" attaches to a heparin-platelet factor 4 protein complex. The antibody then binds to the FcγIIa receptor on the surface of a platelet, resulting in activation, consumption, and thrombocytopenia in the clinical syndrome of heparin-induced thrombocytopenia. In contradistinction to other drug-induced thrombocytopenias that lead to a risk of hemorrhage, the state of thrombocytopenia in heparin-induced thrombocytopenia leads to an acquired hypercoagulability syndrome. Bilateral adrenal hemorrhage associated with heparininduced thrombocytopenia has become an increasingly documented association. The adrenal gland has a vascular construction that lends itself to venous thrombus in the setting of heparin-induced thrombocytopenia and subsequent arterial hemorrhage. A literature search revealed 17 reported cases of bilateral adrenal hemorrhage in the setting of heparin-induced thrombocytopenia uniformly presenting with complete hemodynamic collapse.Data Sources-An Ovid MEDLINE search of the English-language medical literature was conducted, identifying articles describing cases of bilateral adrenal hemorrhage in the setting of heparin-induced thrombocytopenia.Study Selection-All cases with this association were included in the review. Data Extraction and DataSynthesis-A total of 14 articles were identified, describing 17 individual case reports of bilateral adrenal hemorrhage associated with heparin-induced thrombocytopenia. All cases confirmed known characteristics of heparin-induced thrombocytopenia and uniformly revealed hypotension due to adrenal insufficiency. There were five deaths, resulting in an overall mortality rate of 27.8%, and 100% mortality in the three cases where adrenal insufficiency went unrecognized.Conclusions-The secondary complication of adrenal vein thrombosis leading to bilateral adrenal hemorrhage remains insufficiently recognized and undertreated. The nonspecific presentation of adrenal hemorrhage and insufficiency as a complication of heparin-induced thrombocytopenia, coupled with the catastrophic clinical course of untreated adrenal collapse, requires a high index of suspicion to achieve rapid diagnosis and provide life-saving therapy.

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Section: Literature Reviewmentioning

confidence: 61%

Section: Literature Reviewmentioning

confidence: 97%

Section: Literature Reviewmentioning

confidence: 99%

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Bilateral adrenal hemorrhage: The unrecognized cause of hemodynamic collapse associated with heparin-induced thrombocytopenia*

Rosenberger

Smith

Sawyer

et al. 2011

Critical Care Medicine

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“…Die Komplikation der Nebennierenblutung auf dem Boden einer HIT II ist selten und wurde in der Literatur bisher neunmal beschrieben (4,8,9,23). Anhand der kasuistischen Mitteilungen ist folgender Pathomechanismus vorstellbar: Die arterielle Gefäßversorgung der Nebenniere erfolgt in der Regel über Heruntergeladen von: University of British Columbia.…”

Section: Diskussionunclassified

Seltene Komplikation einer Heparin-induzierten Thrombozytopenie Typ II (HIT II)

Scheffold¹,

Schöngart²,

Berentelg³

et al. 2001

Dtsch med Wochenschr

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“…Shock associated with HIT must raise the suspicion of adrenal insufficiency and BAH. This insidious disorder, if left untreated, is fatal 8–10 …”

mentioning

confidence: 99%

Heparin-Induced Thrombocytopenia: An Increasingly Common Cause of Bilateral Adrenal Hemorrhage

Rosenberger

Smith

Sawyer

2011

Journal of the American Geriatrics Society

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Heparin-Related Thrombocytopenia and Adrenal Hemorrhagic Necrosis Following Aortic Surgery

Cited by 8 publications

References 10 publications

Bilateral adrenal hemorrhage: The unrecognized cause of hemodynamic collapse associated with heparin-induced thrombocytopenia*

Bilateral adrenal hemorrhage: The unrecognized cause of hemodynamic collapse associated with heparin-induced thrombocytopenia*

Seltene Komplikation einer Heparin-induzierten Thrombozytopenie Typ II (HIT II)

Heparin-Induced Thrombocytopenia: An Increasingly Common Cause of Bilateral Adrenal Hemorrhage

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