Knee replacement and HIT without heparin

Warkentin, Theodore E.

doi:10.1182/blood-2015-12-687665

Cited by 6 publications

(6 citation statements)

References 9 publications

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“…that mechanical compression [13] may have facilitated antigen exposure through heightened platelet and/or endothelial activation. [14] It is therefore possible the severe thrombocytopenia in the current patient, without pre-immunization or re-exposure to heparin before, was caused by mechanical compression, causing her blood platelets level to drop dramatically after exposure to heparin. Severe HIT may thus be precipitated by double-hits (both mechanical extrusion and heparin exposure).…”

Section: March 2019 Chinese Medical Sciences Journal 62mentioning

confidence: 88%

Successful Treatment of Severe Heparin-induced Thrombocytopenia with Intravenous Immunoglobulin, Platelet Transfusion and Rivaroxaban: A Case Report

Huang

Lin

Yao

et al. 2019

Chinese Medical Sciences Journal

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Heparin-induced thrombocytopenia (HIT) is a relatively infrequent complication of heparin administration. HIT can cause devastating thrombosis, making it one of the most serious adverse drug reactions encountered in clinical practice. We successfully treated a case of severe HIT presenting with thrombosis and life-threatening bleeding complications with intravenous immunoglobulin (IVIG), platelet transfusion and oral anticoagulant Rivaroxaban. In this case, we considered that IVIG played the most important role by preventing further thrombosis, increasing the platelet count, and ensuring the efficacy of Rivaroxaban. We therefore suggest that IVIG might be the optimal treatment for patients with this urgent condition.

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Section: March 2019 Chinese Medical Sciences Journal 62mentioning

confidence: 88%

Successful Treatment of Severe Heparin-induced Thrombocytopenia with Intravenous Immunoglobulin, Platelet Transfusion and Rivaroxaban: A Case Report

Huang

Lin

Yao

et al. 2019

Chinese Medical Sciences Journal

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“…38 The formation of PF4/heparin antibodies is unusual among healthy individuals, but it is observed in inflammation, cardiopulmonary and orthopedic surgery, suggesting that platelet and endothelial activation play a significant role. 39,40 There is a belief that prior antigen exposure, lead to early appearance (4-5 days) of 'isotype-switched antibodies' . 41,42 Moreover, it is cleared that PF4 binds to bacterial lipopolysaccharides and platelets.…”

Section: Discussionmentioning

confidence: 99%

Postoperative Low Molecular Weight Heparin-induced Infection in Gastrointestinal Cancer Patients. A 2-year Single Centre Experience 

Nikova¹,

Kyriazi²,

Michalopoulou³

et al. 2020

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Introduction: Patients with gastrointestinal cancer are at high risk of developing thrombosis and postoperative infection. Antico-agulation therapy for such patients is provided by low molecular weight heparin (LMWH) and elastic stockings. The latter, however, is linked to immunoregulatory activities and immunosuppression in vivo and in vitro. Aim: Therefore, the present study aimed to examine the link between LMWH and infection in patients with gastrointestinal cancer. Materials and methods: The study is a retrospective report of 51 patients operated on at the Second Department of Surgery at Metaxa Cancer Hospital. The sample was divided into groups based on the presence or absence of diabetes and preoperative anticoagu-lation therapy. Afterwards, the data were statistically analysed.  Results: The results of the study show a statistically significant correlation between LMWH and infection. Moreover, the risk of infec-tion increases by 13.3% for each day of heparin intake. The theory of this correlation is explained in detail.  Conclusions: The findings of the present study raise an essential question about postoperative management of cancer patients. How-ever, the study sample size is rather small so further studies with larger sample size are required to give greater credence to results.

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“…Interestingly, one study suggested that inflammatory stimuli and platelet activation due to tissue injury upon joint replacement surgery would suffice to evoke anti-PF4/heparin antibodies in the absence of heparin treatment [39, 40]. Anti-PF4/heparin antibodies were detected in 6.5% of patients with arthroplasty in the absence of heparin and in 15% when dynamic compression as thromboprophylaxis was applied.…”

Section: Discussionmentioning

confidence: 99%

“…Inflammatory stimuli by bacterial infection [35, 36] or by tissue damage upon surgery or major trauma are also considered promoting development of HIT [37, 38]. Interestingly, a recent study in orthopedic patients after knee or hip arthroplasty reported anti-PF4/heparin antibody formation in the absence of heparin treatment which was enhanced by dynamic versus static compression therapy for thromboprophylaxis [39, 40]. …”

Section: Introductionmentioning

confidence: 99%

Anti-Platelet Factor 4/Heparin Antibody Formation Occurs Endogenously and at Unexpected High Frequency in Polycythemia Vera

Meyer

Steinmann

Lehmann

et al. 2017

BioMed Research International

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Background Myeloproliferative neoplasms (MPN) encounter thromboses due to multiple known risk factors. Heparin-induced thrombocytopenia (HIT) is a thrombotic syndrome mediated by anti-platelet factor 4 (PF4)/heparin antibodies with undetermined significance for thrombosis in MPN. We hypothesized that anti-PF4/heparin Ab might occur in MPN and promote thrombosis. Methods Anti-PF4/heparin antibodies were analyzed in 127 MPN patients including 76 PV and 51 ET. Screening, validation testing, and isotype testing of anti-PF4/heparin Ab were correlated with disease characteristics. Results Anti-PF4/heparin antibodies were detected in 21% of PV and 12% of ET versus 0.3–3% in heparin-exposed patients. Validation testing confirmed anti-PF4/heparin immunoglobulins in 15% of PV and 10% of ET. Isotype testing detected 9.2% IgG and 5.3% IgM in PV and exclusively IgM in ET. IgG-positive PV patients encountered thromboses in 57.1% suggesting anti-PF4/heparin IgG may contribute to higher risk for thrombosis in MPN. Overall, 45% of PV patients experienced thromboses with 11.8% positive for anti-PF4/heparin IgG versus 7.1% in PV without thrombosis. Conclusion Anti-PF4/heparin antibodies occur endogenously and more frequently in MPN than upon heparin exposure. Thrombotic risk increases in anti-PF4/heparin IgG-positive PV reflecting potential implications and calling for larger, confirmatory cohorts. Anti-PF4/heparin IgG should be assessed upon thrombosis in PV to facilitate avoidance of heparin in anti-PF4/heparin IgG-positive PV.

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Knee replacement and HIT without heparin

Cited by 6 publications

References 9 publications

Successful Treatment of Severe Heparin-induced Thrombocytopenia with Intravenous Immunoglobulin, Platelet Transfusion and Rivaroxaban: A Case Report

Successful Treatment of Severe Heparin-induced Thrombocytopenia with Intravenous Immunoglobulin, Platelet Transfusion and Rivaroxaban: A Case Report

Postoperative Low Molecular Weight Heparin-induced Infection in Gastrointestinal Cancer Patients. A 2-year Single Centre Experience

Anti-Platelet Factor 4/Heparin Antibody Formation Occurs Endogenously and at Unexpected High Frequency in Polycythemia Vera

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Knee replacement and HIT without heparin

Cited by 6 publications

References 9 publications

Successful Treatment of Severe Heparin-induced Thrombocytopenia with Intravenous Immunoglobulin, Platelet Transfusion and Rivaroxaban: A Case Report

Successful Treatment of Severe Heparin-induced Thrombocytopenia with Intravenous Immunoglobulin, Platelet Transfusion and Rivaroxaban: A Case Report

Postoperative Low Molecular Weight&nbsp;Heparin-induced Infection in Gastrointestinal Cancer Patients. A 2-year Single Centre Experience&nbsp;

Anti-Platelet Factor 4/Heparin Antibody Formation Occurs Endogenously and at Unexpected High Frequency in Polycythemia Vera

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Postoperative Low Molecular Weight Heparin-induced Infection in Gastrointestinal Cancer Patients. A 2-year Single Centre Experience