The Incidence of Heparininduced Thrombocytopenia in Hospitalized Medical Patients Treated With Subcutaneous Unfractionated Heparin: A Prospective Cohort Study

Abstract

The authors conducted a prospective cohort follow-up study in 598 medical patients to determine the incidence of heparin-induced thrombocytopenia or venous thrombotic events as a complication of intravenous unfractionated heparin. Patients were admitted to two medical wards and treated with subcutaneous unfractionated heparin for either therapeutic or prophylactic indications. Platelet count was performed at baseline and then every 3 days. Based on the author's definition of heparin-induced thrombocytopenia, five patients who received heparin for prophylactic indications developed heparin-induced thrombocytopenia. Thromboembolic complications were more common in patients with heparin-induced thrombocytopenia (60%). The authors concluded that HIT and thromboembolic complications are relatively uncommon adverse effects of subcutaneous unfractionated heparin and suggest replacement of unfractionated heparins with low-molecular-weight heparins.

Keywords

heparin-induced thrombocytopenia intravenous unfractionated heparin thromboembolic complications

Get full access to this article

View all access options for this article.

References

1. Chong BH . Heparin-induced thrombocytopenia. J Thromb Haemost 1:1471-1478, 2003.

2. Warkentin TE . Heparin-induced thrombocytopenia: pathogenesis and management. Br J Haematol 121:535-555, 2003.

3. Kappers-Klunne MC , Boon DM , Hop WC , et al: Heparininduced thrombocytopenia and thrombosis: A prospective analysis of the incidence in patients with heart and cerebrovascular diseases. Br J Haematol 96(3):442-446, 1997.

4. Warkentin TE , Sheppard JAI , Horsewood P , et al: Impact of the patient population on the risk for heparininduced thrombocytopenia. Blood 96(5):1703-1708, 2000.

5. Warkentin TE , Levine MN , Hirsh J , et al: Heparin-induced thrombocytopenia in patients treated with lowmolecular-weight heparin or unfractionated heparin. N Engl J Med 332:1330-1335, 1995.

6. Leyvraz PF , Bachmann F , Hoek J , et al:. Prevention of deep vein thrombosis after hip replacement: Randomised comparison between unfractionated heparin and low molecular weight heparin. BMJ 303:543-548, 1991.

7. Pouplard C , May MA , Iochmann S , et al: Antibodies to platelet factor 4-heparin after cardiopulmonary bypass in patients anticoagulated with unfractionated heparin or a low-molecular-weight heparin. Clinical implications for heparin-induced thrombocytopenia. Circulation 99:2530-2536, 1999.