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
Keywords
Related Articles
- EP ID EP14080
- DOI -
- Views 321
- Downloads 9
Selective Use of 18F-Fluorodeoxyglucose-Positron Emission Tomography and Computed Tomography in the Management of Metastatic Disease from Colorectal Cancer Results from a regional centre
Objectives: Computed tomography (CT) scans are routinely used for primary staging and disease surveillance in patients with colorectal cancer. However, these scans have limited sensitivity in some organs and can only d...
Cardiovascular Complications of Acute Amphetamine Abuse Cross-sectional study
Objectives: Tis study aimed to evaluate cardiovascular complications among patients who abuse amphetamines. Methods: Tis cross-sectional study took place between April 2014 and April 2015 among 3,870 patients referred...
Needle Stick and Sharp Injuries Among Healthcare Workers: A retrospective six-year study
Objectives: This study aimed to examine the proportion of needle stick and sharp injuries (NSSIs) among healthcare workers at King Hussein Medical Center (KHMC), Amman, Jordan. Methods: All NSSI reports referred from dep...
A Practical Guide to the Genetic Family History
Perceptions and Attitudes of First-Year Medical Students on a Modifed Team-Based Learning (TBL) Strategy in Anatomy
Objectives: Although team-based learning (TBL) is widely used in medical education, its evaluation from the perspectives of the students exposed to it has been limited. Tis paper reports on a quantitative and qualitati...