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Current agents for the treatment of patients with heparin-induced thrombocytopenia

, : Current agents for the treatment of patients with heparin-induced thrombocytopenia. Current Opinion in Pulmonary Medicine 8(5): 405-412

Several counterintuitive treatment paradoxes complicate the management of immune heparin-induced thrombocytopenia (HIT). For example, simple discontinuation of heparin often fails to prevent subsequent HIT-associated thrombosis. Thus, current treatment guidelines recommend substituting heparin with a rapidly acting alternative anticoagulant (eg, danaparoid, lepirudin, or argatroban) even when HIT is suspected on the basis of thrombocytopenia alone ("isolated HIT"). Another paradox-coumarin (warfarin) anticoagulation-can lead to venous limb gangrene in a patient with HIT-associated deep-vein thrombosis. Thus, warfarin is not recommended during acute thrombocytopenia secondary to HIT. However, warfarin can be given as overlapping therapy with an alternative anticoagulant, provided that (1) initiation of warfarin is delayed until substantial platelet count recovery has occurred (to at least above 100 x 10(9)/L); (2) low initial doses of warfarin are used; (3) at least 5 days of overlapping therapy are given; and (4) the alternative agent is maintained until the platelet count has normalized. It has recently been recognized that HIT antibodies are transient and usually do not recur upon subsequent re-exposure to heparin. This leads to a further paradox-patients with previous HIT can be considered for a brief re-exposure to heparin under exceptional circumstances; for example, heart surgery requiring cardiopulmonary bypass, if HIT antibodies are no longer detectable using sensitive assays. For patients with acute or recent HIT who require urgent heart surgery, other approaches include use of alternative anticoagulants (eg, lepirudin or danaparoid) for cardiopulmonary bypass or antiplatelet agents (eg, tirofiban or epoprostenol) to permit intraoperative use of heparin.


PMID: 12172444

Other references

Costa, L.M., 2012: From biological warfare to the brighter side of rice research. Plant & Cell Physiology 53(4): 603-605

Okazaki, R.; Kornberg, A., 1964: Deoxythymidine Kinase Of Escherichia Coli. I. Purification And Some Properties Of The Enzyme. Journal of Biological Chemistry 239: 269-274

Tu, Y.; Kucik, D.F.; Wu, C., 2001: Identification and kinetic analysis of the interaction between Nck-2 and DOCK180. Nck-2 is a newly identified adapter protein comprising three N-terminal SH3 domains and one C-terminal SH2 domain. We have identified in a yeast two-hybrid screen DOCK180, a signaling protein implicated in the regulation of membrane ruffling and m...

Börner, H.; Falkenhagen, D.; Rohmann, H.; Krüger, M., 1976: Behavior of plasms renin activity, hemodynamic parameters and clearance values as influenced by orciprenaline and propranolol in patients with limited kidney function. Zeitschrift für Urologie und Nephrologie 69(12): 877-884

Nakazawa, M.; Nakashima, T.; Kubota, H.; Seikai, S., 1987: 65-femtosecond pulse generation from a synchronously pumped dye laser without a colliding-pulse mode-locking technique. Optical pulses as short as 65 fsec have been successfully generated from a synchronously pumped dye laser that does not employ a colliding pulse mode-locking technique. The laser consists of a linear cavity with two dye jets (a gain jet with R6G a...

Hungerland., 1950: Chlorine metabolism. The question is discussed, with illustrations from cases, whether chlorine exists in the human body in other than the ionic state. The author believes that it does.

Jakoby, W.B.; Ziegler, D.M., 1990: The enzymes of detoxication. Journal of Biological Chemistry 265(34): 20715-8

Rudall, P.J.; Stuppy, W.; Cunniff, J.; Kellogg, E.A.; Briggs, B.G., 2005: Evolution of reproductive structures in grasses (Poaceae) inferred by sister-group comparison with their putative closest living relatives, Ecdeiocoleaceae. Despite much recent activity in the phylogeny and developmental genetics of grasses, the enigmatic homologies of their reproductive structures remain largely unresolved, partly because their highly derived morphology has resulted in a unique assoc...

Tsuji S.; Sakoda M.; Asami M.; Ohsawa K.; Ikemura Y.; Okuno T.; Washio S.; Inoue E., 1967: Nosological study on peptic ulcer endocrine factor in peptic ulcer abstract human neopl pituitary adenomas. Gastroenterologia Japonica 2(4): 338

Ahern, J., 1990: Nurses' influence projected to grow during nineties. American Nurse 22(3): 9-9