Risk of thrombosis in patients with malignancy and heparin‐induced thrombocytopenia

Abstract

Heparin-induced thrombocytopenia (HIT) is a common immunological drug reaction. After exposure to heparin, some patients develop heparin dependent antibodies with no evidence of thrombosis, while others are at risk of thrombocytopenia, thrombosis, limb loss, and death. We conducted a retrospective chart review on all patients serologically positive for HIT by HPIA ELISA in a single tertiary-care hospital, to determine whether patients with malignancy had an increased risk of thrombotic complications. Medical records of 55 patients who tested positive for HIT and met clinical criteria for HIT were analyzed. All patients had been treated with unfractionated heparin. Malignancy was diagnosed in 11 patients, either at surgery or post-mortem examination. A higher rate of venous thrombosis and pulmonary embolism was observed in patients with HIT and malignant disease when compared to patients with no underlying malignancy (odds ratio 13.6, 95% CI 2.9 -63.8). Am.

Heparin-Induced Thrombocytopenia in Cardiovascular Patients

“…40 Other clinical risk factors are concomitant malignancy, female gender, and higher PF4/heparin antibody titer. 41,42 Also, Kelton et al described that the severity of thrombocytopenia predicts a worse prognosis, such as thrombotic progression, amputation, or death. 43 Both arterial and venous thrombosis can occur, with a higher likelihood of occurrence in the localized vascular injury site.…”

Long-term use of daily subcutaneous low molecular weight heparin in cancer patients with venous thromboembolism: why hesitate any longer?

“…The incidence of thrombopenia was identical with the long-term use of LMWH and VKA as assessed in the LITE [28], the CANTHANOX [50] and in the Sideras [64] studies. A retrospective study of patients treated with UFH found 55 episodes of HIT, including 11 in the cancer patients, but did not allow for an estimation of the prevalence of HIT in cancer patients [55]. From two prospectively evaluated groups of 598 patients treated with UFH and 1,754 patients under LMWH, extrapolation of the data estimated a HIT frequency of 1.5% (5/335) in the subgroup of cancer patients [59].…”

Venous thromboembolism in abdominal cancer surgery

“…Historically, unfractionated heparin has long been used for VTE prevention in high risk patients. However, because of the burden of monitoring coagulation activity and adverse events such as heparin-induced thrombocytopenia (HIT) [22], sophisticated anticoagulants, such as low molecular heparin (LMWH) or fondaparinux, a pentasaccharide molecule exerting its anticoagulant activity through binding to antithrombin-III, were developed and now are widely used for perioperative thromboprophylaxis throughout the world. Enoxaparin (LMWH) and fondaparinux are now available in Japan.…”