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The Journal of Cardiovascular Surgery 1999 April;40(2):237-42

Copyright © 2000 EDIZIONI MINERVA MEDICA

language: English

Heparin-induced vascular occlusion in vasculosurgical patients. An evaluation of the disease in 13 cases

Buerger Th., Tautenhahn J., Meyer F., Lippert H.

From the Hospital for General, Abdominal and Vascular Surgery Surgical Center, Medical Faculty Otto von Guericke University Magdeburg, Germany


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Objective. To ­describe the diag­no­sis and treat­ment of ­adverse reac­tion to hep­ar­in (hep­ar­in-­induced throm­bo­cy­to­pe­nia [HIT]) admin­is­tered proph­y­lac­ti­cal­ly for throm­bo­sis and embo­lism. Experimental ­design: case ­series. Setting: vascular sur­gi­cal divi­sion in a Uni­ver­sity hos­pi­tal. Patients: thirteen ­patients treat­ed for HIT ­type II ­between October 1994 and June 1997. Measures/ Interventions: diagnosis of hep­ar­in-­induced com­pli­ca­tions is ­based on ­exact med­i­cal his­to­ry and reg­u­lar meas­ure­ment of plate­let ­counts. Confirmation can be ­obtained ­with the aggre­ga­tion ­test, serot­o­nin-­release ­test, hep­ar­in-­induced plate­let ­release (­HIPA) ­test, and plate­let fac­tor 4/hep­ar­in ­ELISA. Vasculosurgical recon­struc­tion is usu­al­ly ­required to elim­i­nate ves­sel occlu­sion.
Results. In our ­series, HIT was con­firmed by ­HIPA ­test (11 ­patients) and aggre­ga­tion ­test (2 ­patients). All ­patients had pos­i­tive ­cross reac­tion ­with low-molec­u­lar-­weight hep­ar­in, and six had ­cross reac­tion ­with hepar­i­noid dan­a­proid sodi­um (Orgaran®). Occlusions ­occurred ­between day 2 and 22 ­after the ­start or resump­tion of hep­ar­in admin­is­tra­tion (­mean, 11 ­days). Anticoagulation treat­ment ­with hir­u­din or dan­a­proid sodi­um was giv­en to 5 ­patients, in con­junc­tion ­with vas­cu­lo­sur­gi­cal recon­struc­tion. Three of ­those ­patients ­died and the oth­er two ­required ampu­ta­tion.
Conclusions. Heparin-­induced vas­cu­lar occlu­sion is a ­rare but ­severe ­adverse ­effect of hep­ar­in treat­ment. When HIT is sus­pect­ed, hep­ar­in admin­is­tra­tion ­must be ­stopped, ­with sub­sti­tu­tion of dex­tran and acet­yl­sal­i­cyl­ic ­acid. Laboratory ­tests ­must be ­used for con­fir­ma­tion or exclu­sion. However, the diag­no­sis can be ­obscured by a nor­mal plate­let ­count due to pre-­ex­ist­ing poly­cy­the­mia and by ­false-neg­a­tive ­test ­results. Surgery is usu­al­ly war­rant­ed, depend­ing on the ­degree and local­iza­tion of ische­mia.

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