Physicians involved in the care of patients with cardiac and vascular problems regularly employ heparin in treatment regimens of inpatients and outpatients. Heparin-induced thrombocytopenia is an important complication that can result in significant morbidity and mortality. It is reasonable, therefore, to review the pathogenetic mechanisms involved, the identification of heparin-induced thrombocytopenia, and the management to minimize morbidity and mortality.
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References
1.
Murray D, Jacques L, Perrett T, et al: Heparin and the thrombosis of veins following injury. Surgery2:163-187, 1937.
Rhodes GR, Dixon RH, Silver D: Heparin induced thrombocytopenia with thrombotic and hemorrhagic manifestations. Surg Gynecol Obstet136:409-416, 1973.
4.
Shuster TA, Silliman R, Coats RD, et al: Heparin-induced thrombocytopenia twenty-nine years later. J Vasc Surg38:1316-1322, 2003.
5.
Aster RH: Heparin-induced thrombocytopenia and thrombosis. N Engl J Med332:1374-1376, 1995.
6.
Chong BH, Newman PM:The antigenic epitope in heparin-induced thrombocytopenia resides solely on platelet factor 4. Blood90(suppl 1):461a, 1997.
7.
Bacsi S, Geoffrey R, Gorski J, et al: Antigen-specific expansion of T cell clonotypes in heparin-induced thrombocytopenia/thrombosis (HITT) patient cultured T cells. Blood90(suppl 1):403a, 1997.
8.
Greinacher A, Liebenhoff U, Kiefel V, et al: Heparin-associated thrombocytopenia: The effects of various IgG preparations on antibody-mediated platelet activation—a possible indication for high-dose IV IgG. Thromb Haemost71:641-645, 1994.
9.
Warkentin TE, Kelton JG: Delayed-onset heparin-induced thrombocytopenia and thrombosis. Ann Intern Med135:502-506, 2001.
10.
Warkentin TE, Greinacher A: Heparin-induced thrombocytopenia and cardiac surgery. Ann Thorac Surg76:638-652, 2003.
11.
Pouplard C, Marc-Antoine M, Iochmann S, et al: Antibodies to platelet factor 4-heparin after cardiopulmonary bypass in patients anticoagulated with unfractionated heparin or low-molecular-weight heparin. Circulation29:779-786, 1999.
