Successful Use of Alternative Anticoagulants in the Management of Heparin-induced Thrombocytopenia with Thrombotic Complications Report of 5 cases and review of literature
Journal Title: Sultan Qaboos University Medical Journal - Year 2011, Vol 11, Issue 3
Abstract
Heparin is one of the most frequently used anticoagulants. It is easy to use, but can be associated with life-threatening side effects. One of these is heparin-induced thrombocytopenia syndrome (HITS), which develops in about 3–5% of patients exposed to heparin and is associated with thrombosis in 1% of cases. We report here the successful treatment of fve patients with HITS who were treated with alternative anticoagulants namely danaparoid or hirudin. Te median time between their exposure to heparin and onset of symptoms and or signs was 10.2 days (range 7–14 days). Platelet counts decreased to a mean of 38.4 x 109 /l (12–82 x 109/l). All fve patients had evidence of thrombosis; four patients had clinical and radiological evidence of pulmonary emboli, one patient had confrmed deep vein thrombosis (DVT) and one patient had extensive skin necrosis of the thighs and abdomen. Platelet aggregation test were positive in two patients, inconclusive in one patient and negative in two patients. Two patients were anticoagulated with danaparoid and three with hirudin until their platelet counts returned to normal between 4 and 14 days (average 6 days) following the recognition of the syndrome. Our patients had signifcant morbidity, but no mortality. Immediate withdrawal of heparin is of paramount importance and introduction of alternative anticoagulant is necessary in the presence of thrombosis.
Authors and Affiliations
Salam Alkindi| Department of Haematology, Sultan Qaboos University Hospital, Muscat, Oman, Owen P Smith| Department of Haematology, Te Adelaide & Meath Hospital, incorporating the National Children’s Hospital, Tallaght, Dublin, Ireland, Helen Enright| Department of Haematology, Te Adelaide & Meath Hospital, incorporating the National Children’s Hospital, Tallaght, Dublin, Ireland
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