Progressive thrombocytopenia after cardiac surgery in a 67-year-old man

Kopolovic, Ilana; Warkentin, Theodore E.

doi:10.1503/cmaj.131449

Cited by 30 publications

(44 citation statements)

References 19 publications

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“…This in vitro phenomenon is correlated with clinical features of various types of HIT such as delayedonset HIT, 39,40 persisting HIT, 43 fondaparinux-induced HIT, 47 and spontaneous HIT syndrome, 48 and we believe this serological profile explains the potential for recurrent HIT beginning 5 to 10 days after heparin reexposure despite no further heparin being given. These antibodies prompt platelet activation via (non-heparin) plateletassociated glycosaminoglycans.…”

Section: Blood 21 July 2016 X Volume 128 Number 3 How I Treat Patiesupporting

confidence: 57%

“…However, this patient was unusual in another respect: both of his episodes of HIT (in 1998 and 2009) were characterized by the phenomenon of persisting HIT (ie, both HIT episodes lasted for more than 4 weeks before platelet count recovery, which is a rare but recognized course of HIT). 42,43 In addition, the patient developed a generalized maculopapular rash (not a reported feature of HIT). Thus, it is difficult to generalize the outcome of this most unusual patient case.…”

Section: Blood 21 July 2016 X Volume 128 Number 3 How I Treat Patiementioning

confidence: 98%

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How I treat patients with a history of heparin-induced thrombocytopenia

Warkentin

Anderson

2016

Blood

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Heparin-induced thrombocytopenia (HIT) is a relatively common prothrombotic adverse drug reaction of unusual pathogenesis that features platelet-activating immunoglobulin G antibodies. The HIT immune response is remarkably transient, with heparin-dependent antibodies no longer detectable 40 to 100 days (median) after an episode of HIT, depending on the assay performed. Moreover, the minimum interval from an immunizing heparin exposure to the development of HIT is 5 days irrespective of the patient’s previous heparin exposure status or history of HIT. This means that short-term heparin reexposure can be safely performed if platelet-activating antibodies are no longer detectable at reexposure baseline and is recommended when heparin is the clear anticoagulant of choice, such as for cardiac or vascular surgery. The risk of recurrent HIT 1 to 2 weeks after heparin reexposure is ∼2% to 5% and is attributable to formation of delayed-onset (or autoimmune-like) HIT antibodies that activate platelets even in the absence of pharmacologic heparin. Some studies suggest that longer-term heparin reexposure (eg, for chronic hemodialysis) may also be reasonable. However, for other antithrombotic indications that involve patients with a history of HIT (eg, treatment of venous thromboembolism or acute coronary syndrome), preference should be given to non-heparin agents such as fondaparinux, danaparoid, argatroban, bivalirudin, or one of the new direct-acting oral anticoagulants as appropriate.

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Section: Blood 21 July 2016 X Volume 128 Number 3 How I Treat Patiesupporting

confidence: 57%

Section: Blood 21 July 2016 X Volume 128 Number 3 How I Treat Patiementioning

confidence: 98%

How I treat patients with a history of heparin-induced thrombocytopenia

Warkentin

Anderson

2016

Blood

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“…For the 21 patients in group B who received rivaroxaban after transition from another non-heparin anticoagulant, the median duration of preceding non-heparin anticoagulant was only 2 days (range, 1-16 days), with 18 of 21 patients receiving 3 days or fewer of preceding non-heparin anticoagulation; for the 3 patients who received longer preceding non-heparin anticoagulation (for 4 days [ Table 1], 10 days, 28 and 16 days 34 ), the platelet counts were all ,75 3 10 9 /L at DOAC start, and in 2 of the patients (Figure 2), 28 the presence of strong autoimmunelike HIT antibodies was documented, which produced strong platelet activation even in the absence of heparin (persisting HIT).…”

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confidence: 99%

Direct oral anticoagulants for treatment of HIT: update of Hamilton experience and literature review

Warkentin

Pai

Linkins

2017

Blood

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“…Perhaps, they recognize PF4 bound to endogenous polyanions such as chondroitinsulfate or heparansulfate. Thrombocytopenia might last weeks or even months in such patients [5]. Therefore, long-lasting HIT without dependent on heparin is often called "autoimmune HIT."…”

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confidence: 99%