Treatment and Prevention of Heparin-Induced Thrombocytopenia

Warkentin, Theodore E.; Greinacher, Andreas; Koster, Andreas; Lincoff, A. Michael

doi:10.1378/chest.08-0677

Cited by 754 publications

(247 citation statements)

References 249 publications

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“…Taking these criteria together, the diagnosis of HIT becomes likely if the platelet count decreases by > 50% between days 5 and 14 after starting heparin treatment, especially if accompanied by new thrombotic complications. Basically, patients receiving heparin need routine laboratory controls of platelet counts to detect an emerging thrombocytopenia and HIT Ⅱ [7,12] . To this day, no screening procedure exists to detect patients at risk of HIT Ⅱ.…”

Section: Introductionmentioning

confidence: 99%

“…In case of suspected HIT Ⅱ it is important to stop heparin application immediately, initiate laboratory investigations, and switch to a heparin-free anticoagulation regimen such as danaparoid, lepirudin, argatroban, or fondaparinux [12] . In daily clinical practice the 4Ts score (Table 1) has been repeatedly shown to serve as a reliable tool to assess the individual probability of HIT Ⅱ [7,[12][13][14] . A high 4T score together with a positive functional assay are regarded as being confirmatory for HIT.…”

Section: Introductionmentioning

confidence: 99%

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Heparin-induced thrombocytopenia in solid organ transplant recipients: The current scientific knowledge

Aßfalg

Hüser

2016

WJT

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Exposure to heparin is associated with a high incidence of immunization against platelet factor 4 (PF4)/heparin complexes. A subgroup of immunized patients is at risk of developing heparin-induced thrombocytopenia (HIT), an immune mediated prothrombotic adverse drug effect. Transplant recipients are frequently exposed to heparin either due to the underlying end-stage disease, which leads to listing and transplantation or during the transplant procedure and the perioperative period. To review the current scientific knowledge on antiheparin/PF4 antibodies and HIT in transplant recipients a systematic PubMed literature search on articles in English language was performed. The definition of HIT is inconsistent amongst the publications. Overall, six studies and 15 case reports have been published on HIT before or after heart, liver, kidney, and lung transplantation, respectively. The frequency of seroconversion for anti-PF4/heparin antibodies ranged between 1.9% and 57.9%. However, different methods to detect anti-PF4/heparin antibodies were applied. In none of the studies HIT-associated thromboembolic events or fatalities were observed. More importantly, in patients with a history of HIT, reexposure to heparin during transplantation was not associated with thrombotic complications. Taken together, the overall incidence of HIT after solid organ transplantation seems to be very low. However, according to the current knowledge, cardiac transplant recipients may have the highest risk to develop HIT. Different alternative suggestions for heparin-free anticoagulation have been reported for recipients with suspected HIT albeit no official recommendations on management have been published for this special collective so far. Core tip: Heparin-induced thrombocytopenia (HIT) Ⅱ is a life-threatening complication of heparin therapy. Transplant recipients frequently are exposed to high doses of heparin before, during, and after transplantation. This review gives a systematic overview MINIREVIEWS

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Heparin-induced thrombocytopenia in solid organ transplant recipients: The current scientific knowledge

Aßfalg

Hüser

2016

WJT

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“…Several studies have clearly demonstrated the superiority of LMWH in comparison to UH and adjusted dose warfarin with a similar, or superior in the case of warfarin, safety profile [22][23][24]. The risk for heparin induced thrombocytopenia ( HIT) is lower with LMWH than with UH [25]. Effects on symptomatic DVT or PE were not significantly different when LMWH was compared to fondaparinux, however the latter showed an higher bleeding rate leading to re-intervention [26][27][28][29].…”

Section: Low Molecular Weight Heparin ( Lmwh)mentioning

confidence: 99%

Prophylaxis of Venous Thromboembolism in Knee Replacement Surgery

Rostagno¹,

Carulli²,

Cartei³

et al. 2016

Prog Orthop Sci

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Venous thromboembolism (VTE) is still a frequent and sometimes severe complication after knee replacement surgery. Both pharmacological and non-pharmacological measures have been widely used to decrease VTE risk. Non pharmacological treatment include measures directed to decrease the effects of blood stasis, intermittent pneumatic compression device (IPCD) and graduated compression stockings, and mechanical devices. Pharmacological prophylaxis of venous thromboembolism (VTE) is associated with a more significant decrease in the incidence of deep venous thrombosis (DVT) and related complications after knee arthroplasty however anticoagulation may increase the risk of postoperative bleeding and related complications, in particular the need for re-intervention. Aim of present review was to suggest practical approach to DVT prophylaxis in patients undergoing knee arthroplasty. Although parenteral drugs (low dose unfractionated heparin, low molecular weight heparin and fondaparinux) are the more frequently employed agents, limited compliance may be a concern. Recent studies suggest that direct oral anticoagulants, antithrombin and anti Xa agent, might be a useful alternative although safety may limited by an higher rate of local bleeding.

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“…Heparin‐induced thrombocytopenia (HIT) is an immune‐mediated complication that most commonly arises five to 10 days after exposure to heparin or low‐molecular‐weight heparin (LMWH) 1. Heparin‐dependent immunoglobulin (Ig)G antibodies bind to platelet factor 4 (PF4)/heparin complexes on platelets, leading to cross‐linking of platelet FcγIIa receptors.…”

Section: Introductionmentioning

confidence: 99%

“…The most commonly used drugs to treat HIT that are approved by many international health authorities are argatroban and danaparoid (danaparoid is not available in the United States). Although there is evidence showing a reduction in the risk of thromboembolic complications with these drugs, there are also negative consequences associated with their use 1. For argatroban, there is an increased risk of bleeding and its prolongation of the INR makes transition to warfarin after platelet recovery problematic 5.…”

Section: Introductionmentioning

confidence: 99%

Systematic review of fondaparinux for heparin‐induced thrombocytopenia: When there are no randomized controlled trials

Linkins

Warkentin

2018

Research and Practice in Thrombosis and Haemostasis

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BackgroundFondaparinux is commonly used for treatment of heparin‐induced thrombocytopenia (HIT) despite lack of approval for this indication. High quality randomized controlled trials of this agent are unlikely to be forthcoming.ObjectivesThe objective of this systematic review is to update the literature on the efficacy and safety of fondaparinux for treatment of confirmed and probable HIT based on the available evidence.MethodsPrimary articles were identified using Web of Science and PubMed database searches for English‐language studies from January 2006 to November 2017. Selected studies enrolled consecutive adult patients who received fondaparinux as the primary anticoagulant to treat acute HIT; confirmed the diagnosis by serological testing with a serotonin‐release assay; heparin‐induced platelet activation assay or enzyme‐linked immunosorbent assay; provided clinical criteria used to define HIT and reported clinically important outcomes.ResultsA total of 9 studies were identified with 154 HIT positive patients. Ten experienced a new thrombotic event while receiving fondaparinux (6.5%, 95% CI, 3.4 to 11.7%) and 26 experienced major bleeding (16.9%, 95% CI, 11.7 to 23.6%). Mortality due to thrombosis or bleeding was reported in 5 patients (3.2%, 95% CI, 1.2 to 7.6%).ConclusionsFondaparinux appears to be an effective and safe anticoagulant for treatment of acute HIT despite the absence of randomized trials. Caution should exercised when using fondaparinux in patients with renal insufficiency.

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Treatment and Prevention of Heparin-Induced Thrombocytopenia

Cited by 754 publications

References 249 publications

Heparin-induced thrombocytopenia in solid organ transplant recipients: The current scientific knowledge

Heparin-induced thrombocytopenia in solid organ transplant recipients: The current scientific knowledge

Prophylaxis of Venous Thromboembolism in Knee Replacement Surgery

Systematic review of fondaparinux for heparin‐induced thrombocytopenia: When there are no randomized controlled trials

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