Risk factors for unfavorable clinical outcome in patients with documented heparin-induced thrombocytopenia

Elalamy, Ismaı̈l; Tardy‐Poncet, Brigitte; Mulot, A.; Maistre, Emmanuel de; Pouplard, Claire; Nguyên, Philippe; Cleret, Bénédicte; Gruel, Yves; Lecompte, T.; Tardy, Bernard

doi:10.1016/j.thromres.2009.04.002

Cited by 29 publications

(16 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Interestingly, these five patients had at least one thrombosis before argatroban initiation. This observation suggests that patients with an initial thromboembolic event at HIT diagnosis were more likely to present a future thromboembolic event as compared with only isolated thrombocytopenia, as already suggested [ 25 ] and should probably receive higher doses of argatroban. At the same time, dose limitation should be driven by the presence of high hemorrhagic risk in these patients.…”

Section: Discussionsupporting

confidence: 63%

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

Tardy‐Poncet

Nguyên²,

Thiranos

et al. 2015

Crit Care

Self Cite

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionsupporting

confidence: 63%

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

Tardy‐Poncet

Nguyên²,

Thiranos

et al. 2015

Crit Care

Self Cite

View full text Add to dashboard Cite

show abstract

“…Nevertheless, overdiagnosis exposes patients to alternative anticoagulant treatment often associated with increased bleeding risk [16]. On the other hand, delay to the initiation of the alternative treatment increases thrombotic risk and mortality [17]. Laboratory confirmation consisting ideally of the combination of an immunological assay with a functional test would optimize HIT diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Heparin-induced multiple electrode aggregometry is a promising and useful functional tool for heparin-induced thrombocytopenia diagnosis: Confirmation in a prospective study

et al. 2012

Self Cite

View full text Add to dashboard Cite

Heparin-induced thrombocytopenia (HIT) is a potentially lethal adverse effect of heparin therapy. Accurate and rapid HIT laboratory diagnosis when HIT is suspected is crucial. The combination of an immunological assay with a functional test improves the accuracy of HIT, but functional assays are currently limited to a few laboratories. Multiplate® analyzer (Dynabyte, Munich, Germany) is a practical, semi-automated and easy-to-perform platelet aggregation assay. The aim of this study is to explore whether heparin-induced platelet aggregation in whole blood assessed by Multiplate® (Heparin-induced multiple electrode aggregometry, HIMEA) can replace platelet aggregation test (PAT) in platelet-rich plasma. For this purpose, HIMEA performance in HIT diagnosis was prospectively evaluated. HIMEA and PAT were compared to serotonin-release assay (SRA) in 200 well-characterized consecutive patients suspected for HIT. HIMEA was found to be more sensitive (81% vs. 76%) and more specific (99% vs. 96%) than PAT compared to SRA. Both tests showed a high negative predictive value while HIMEA had a better positive predictive value. HIMEA has overall better performance characteristics than PAT for the detection of HIT platelet-activating antibodies. The combination of an immunological assay with HIMEA could be a feasible option in non-specialized laboratories for HIT diagnosis optimization.

show abstract

“…10,11 Superficial vein thrombosis is more common (50%-70%) in women. 1,5,7,8,[12][13][14][15][16][17][18] The great saphenous system is involved in 60% to 80% of the patients, and the small saphenous system in 10% to 20%. 1,7,19,20 Bilateral SVT is reported in 5% to 10% of the patients.…”

Section: Superficial Vein Thrombosis General Considerationsmentioning

confidence: 99%

“…[11][12][13][14][15] Progression to overt thrombosis, which can occur anywhere throughout the venous and arterial circulation, is the most serious complication of HIT, as it often leads to amputation or death. [16][17][18][19] Spontaneous bleeding and petechiae are rare.…”

Section: Heparin-induced Thrombocytopenia General Considerationsmentioning

confidence: 99%

Heparin-Induced Thrombocytopenia

Nicolaides¹,

Fareed²,

Kakkar³

et al. 2013

Clin Appl Thromb Hemost

View full text Add to dashboard Cite

Risk factors for unfavorable clinical outcome in patients with documented heparin-induced thrombocytopenia

Cited by 29 publications

References 21 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 multiple electrode aggregometry is a promising and useful functional tool for heparin-induced thrombocytopenia diagnosis: Confirmation in a prospective study

Heparin-Induced Thrombocytopenia

Contact Info

Product

Resources

About