Page 2236 - Hematology_ Basic Principles and Practice ( PDFDrive )

Chapter 133 Heparin-Induced Thrombocytopenia 1983

13. Rauova L, Hirsch JD, Greene TK, et al: Monocyte-bound PF4 in the
ANTICOAGULATION AND PREVIOUS HEPARIN-INDUCED pathogenesis of heparin-induced thrombocytopenia. Blood 116:5021,
THROMBOCYTOPENIA 2010.
14. Lubenow N, Hinz P, Thomaschewski S, et al: The severity of trauma
HIT antibodies are transient and usually are undetectable several determines the immune response to PF4/heparin and the frequency of
17
weeks or a few months after an episode of HIT. If HIT antibodies heparin-induced thrombocytopenia. Blood 115:1797, 2010.
are no longer detected, it is appropriate to use heparin for a brief 15. Warkentin TE, Cook RJ, Marder VJ, et al: Anti-PF4/heparin antibody
indication in situations where other anticoagulants have drawbacks, formation post-orthopedic surgery thromboprophylaxis: the role of
for example, cardiac surgery. 17,26,27,35 Heparin should be avoided pre- non-drug risk factors and evidence for a stoichiometry-based model of
operatively (e.g., argatroban or bivalirudin can be used for heart immunization. J Thromb Haemost 8:504, 2010.
catheterization). The risk of recurrent HIT appears to be low (approxi- 16. Warkentin TE: Drug-induced immune-mediated thrombocytopenia—
mately 2%), but is possible beginning approximately one week post- from purpura to thrombosis. N Engl J Med 356:891, 2007.
reexposure for cardiac or vascular surgery even if postoperative heparin 17. Warkentin TE, Kelton JG: Temporal aspects of heparin-induced throm-
is not given, because of the possibility of regenerating strong HIT bocytopenia. N Engl J Med 344:1286, 2001.
antibodies that can activate platelets in the absence of pharmacologic 18. Warkentin TE, Kelton JG: Delayed-onset heparin-induced thrombocy-
35
heparin. Alternatively, if a patient with recent HIT remains SRA+ topenia and thrombosis. Ann Intern Med 135:502, 2001.
and heparin reexposure is desired (e.g., for urgent cardiac surgery), 19. Warkentin TE, Basciano PA, Knopman J, et al: Spontaneous heparin-
therapeutic plasma exchange can be used to remove HIT antibodies induced thrombocytopenia syndrome. Blood 123:3651, 2014.
preoperatively; in this situation, achieving a negative SRA is the 20. Warkentin TE, Safyan EL, Linkins LA: Heparin-induced thrombocyto-
appropriate serologic endpoint (as the EIA can remain positive even penia presenting as bilateral adrenal hemorrhages. N Engl J Med 372:492,
when platelet-activating antibodies are no longer detectable by SRA). 36 2015.
Patients with acute or recent HIT who require urgent heart surgery 21. Warkentin TE, Cook RJ, Sarode R, et al: Warfarin-induced venous limb
and still have detectable antibodies have been successfully treated with ischemia/gangrene complicating cancer: a novel and clinically distinct
alternate anticoagulant approaches (e.g., bivalirudin, or heparin plus syndrome. Blood 126:486, 2015.
an antiplatelet agent such as epoprostenol or tirofiban), but each of 22. Pauzner R, Greinacher A, Selleng K, et al: False-positive tests for heparin
these approaches has disadvantages. For example, epoprostenol causes induced thrombocytopenia in patients with antiphospholipid syndrome
hypotension, and there is limited experience with its use in cardiac and systemic lupus erythematosus. J Thromb Haemost 7:1070, 2009.
surgery. Bivalirudin is the most promising agent for use in cardiac 23. Lo GK, Juhl D, Warkentin TE, et al: Evaluation of pretest clinical score
surgery, but special surgical and anesthesiologic maneuvers are required (4 T’s) for the diagnosis of heparin-induced thrombocytopenia in two
(because bivalirudin undergoes proteolysis, thus posing a risk for clot- clinical settings. J Thromb Haemost 4:759, 2006.
ting of stagnant blood in the extracorporeal circuit). 24. Cuker A, Arepally G, Crowther MA, et al: The HIT Expert Probability
A diagnostic and therapeutic approach to HIT is shown in the (HEP) Score: a novel pre-test probability model for heparin-induced
box on Diagnosis and Treatment of Heparin-Induced Thrombo- thrombocytopenia based on broad expert opinion. J Thromb Haemost
cytopenia. 8:2642, 2010.
25. Warkentin TE: How I diagnose and manage HIT. Hematology Am Soc
Hematol Educ Program 2011:143, 2011.
REFERENCES 26. Warkentin TE, Greinacher A, Koster A, et al: Treatment and preven-
tion of heparin-induced thrombocytopenia: American College of Chest
1. Linkins LA, Lee DH: Frequency of heparin-induced thrombocytopenia. Physicians Evidence-Based Clinical Practice Guidelines (8th edition).
In Warkentin TE, Greinacher A, editors: Heparin-induced thrombocyto- Chest 133:340S, 2008.
penia, ed 5, Boca Raton, FL, 2013, CRC Press, p 110. 27. Linkins LA, Dans AL, Moores LK, et al: Treatment and prevention
2. Warkentin TE, Sheppard JI, Moore JC, et al: Laboratory testing for the of heparin-induced thrombocytopenia. Antithrombotic Therapy and
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3. Warkentin TE, Sheppard JI, Moore JC, et al: Studies of the immune 28. Warkentin TE: Fondaparinux: does it cause HIT? Can it treat HIT?
response in heparin-induced thrombocytopenia. Blood 113:4963, 2009. Expert Rev Hematol 3:567, 2010.
4. Warkentin TE: HIT paradigms and paradoxes. J Thromb Haemost 9:105, 29. Lobo B, Finch C, Howard A, et al: Fondaparinux for the treatment
2011. of patients with acute heparin-induced thrombocytopenia. Thromb
5. Warkentin TE, Sheppard JI, Moore JC, et al: Quantitative interpretation Haemost 99:208, 2008.
of optical density measurements using PF4-dependent immunoassays. 30. Warkentin TE, Pai M, Sheppard JI, et al: Fondaparinux treatment of
J Thromb Haemost 6:1304, 2008. acute heparin-induced thrombocytopenia confirmed by the serotonin-
6. Warkentin TE, Sheppard JI, Sigouin CS, et al: Gender imbalance and release assay: a 30-month, 16-patient case series. J Thromb Haemost
risk factor interactions in heparin-induced thrombocytopenia. Blood 9:2389, 2011.
108:2937, 2006. 31. Goldfarb MJ, Blostein MD: Fondaparinux in acute heparin-induced
7. Warkentin TE, Cook RJ, Marder VJ, et al: Anti-platelet factor 4/heparin thrombocytopenia: a case series. J Thromb Haemost 9:2501, 2011.
antibodies in orthopedic surgery patients receiving antithrombotic 32. Kang M, Alahmadi M, Sawh S, et al: Fondaparinux for the treatment
prophylaxis with fondaparinux or enoxaparin. Blood 106:3791, 2005. of suspected heparin-induced thrombocytopenia: a propensity score-
8. Gao C, Boylan B, Fang J, et al: Heparin promotes platelet responsiveness matched study. Blood 125:924, 2015.
by potentiating αIIbβ3-mediated outside-in signaling. Blood 117:4946, 33. Warkentin TE, Davidson BL, Büller HR, et al: Prevalence and risk of
2011. preexisting heparin-induced thrombocytopenia antibodies in patients
9. Sheridan D, Carter J, Kelton JG: A diagnostic test for heparin-induced with acute VTE. Chest 140:366–373, 2011.
thrombocytopenia. Blood 67:27, 1986. 34. Warkentin TE: Anticoagulant failure in coagulopathic patients:
10. Krauel K, Weber C, Brandt S, et al: Platelet factor 4 binding to lipid PTT confounding and other pitfalls. Expert Opin Drug Saf 13:25,
A of Gram-negative bacteria exposes PF4/heparin-like epitopes. Blood 2014.
120:3345, 2012. 35. Warkentin TE, Sheppard JI: Serological investigation of patients with
11. Warkentin TE, Kelton JG: A 14-year study of heparin-induced throm- a previous history of heparin-induced thrombocytopenia who are reex-
bocytopenia. Am J Med 101:502, 1996. posed to heparin. Blood 123:2485, 2014.
12. Warkentin TE, Elavathil LJ, Hayward CPM, et al: The pathogenesis of 36. Warkentin TE, Sheppard JI, Chu FV, et al: Plasma exchange to remove
venous limb gangrene associated with heparin-induced thrombocytope- HIT antibodies: dissociation between enzyme-immunoassay and platelet
nia. Ann Intern Med 127:804, 1997. activation test reactivities. Blood 125:195, 2015.