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Heparin-induced thrombocytopenia.

B H Chong1

  • 1Department of Haematology, St George Hospital, Kogarah, Australia.

Blood Reviews
|June 1, 1988
PubMed
Summary

Heparin therapy can cause two types of thrombocytopenia: mild and severe. Severe heparin-induced thrombocytopenia is immune-mediated, leading to dangerous blood clots and requiring immediate treatment.

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Area of Science:

  • Hematology
  • Pharmacology
  • Immunology

Background:

  • Heparin therapy, derived from bovine or porcine sources, is associated with thrombocytopenia, a decrease in platelet count.
  • Two distinct clinical forms of heparin-induced thrombocytopenia (HIT) exist: early-onset mild thrombocytopenia and delayed-onset severe thrombocytopenia.
  • Severe HIT poses significant risks, including thromboembolic complications like limb gangrene and mortality, often linked to an IgG heparin-dependent platelet antibody.

Purpose of the Study:

  • To differentiate between the two main clinical types of heparin-induced thrombocytopenia.
  • To elucidate the underlying mechanisms and diagnostic approaches for HIT.
  • To outline management strategies for patients experiencing heparin-induced thrombocytopenia.

Main Methods:

  • Clinical observation and classification of thrombocytopenia based on onset and severity.
  • In vitro diagnostic confirmation using platelet aggregometry or [14C] serotonin release assay to detect heparin-dependent antibodies.
  • Review of treatment outcomes for various management strategies.

Main Results:

  • Mild thrombocytopenia is likely caused by heparin's direct platelet proaggregating effect and is generally asymptomatic.
  • Severe thrombocytopenia results from an immune mechanism involving IgG heparin-dependent antibodies, leading to platelet aggregation and thromboxane production.
  • Diagnosis is clinical, supported by laboratory confirmation of the antibody.

Conclusions:

  • Heparin-induced thrombocytopenia presents as either mild or severe, with distinct mechanisms and clinical implications.
  • Management of severe HIT involves discontinuing heparin, initiating warfarin, and potentially adding antiplatelet agents or dextran.
  • Low molecular weight heparin shows promise in managing HIT, while mild cases require close monitoring.

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