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1: Intensive Care Med. 2004 Oct;30(10):1927-34. Epub 2004 May 20.
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Thrombosis and hemorrhage in heparin-induced thrombocytopenia in seriously ill patients.

Wester JP, Haas FJ, Biesma DH, Leusink JA, Veth G.

Division of Intensive Care Medicine, Department of Internal Medicine, St. Antonius Hospital, PO Box 2500, 3430 EM Nieuwegein, The Netherlands. j.p.j.wester@olvg.nl

OBJECTIVE: Heparin-induced thrombocytopenia (HIT) is the most common form of drug-induced immune-mediated thrombocytopenia. HIT may be aggravated by life-threatening arterial and venous thrombosis and, to a lesser extent, hemorrhagic complications. We investigated the incidence of thromboembolic and hemorrhagic complications in critically ill patients with the multiple organ dysfunction syndrome and HIT. DESIGN: Case-control study. SETTING: A 33-bed general intensive care unit in a university-affiliated teaching hospital. PATIENTS: Twenty consecutive patients with laboratory-proven HIT compared with 20 contemporary, consecutive patients without HIT. INTERVENTIONS: Unfractionated heparin or low-molecular-weight heparin were replaced by danaparoid sodium in patients with HIT. MEASUREMENTS AND RESULTS: Heparin-induced thrombocytopenia was proven by a positive platelet aggregation test. The HIT group consisted of 14 males and 6 females aged 65.2+/-10.8 years (mean +/- standard deviation) with APACHE II scores of 26.7+/-5.4. Thrombocytopenia less than 100 x 10(9)/l developed within 6.4+/-7.0 days. In 12 patients thrombocytopenia resolved after discontinuation of unfractionated heparin in 8.8+/-6.4 days. Arterial and venous thromboembolic complications occurred more frequently in HIT patients than in non-HIT patients (10/20 (50%) versus 0/20 (0%); chi-square p<0.001). Hemorrhagic complications also occurred more frequently in HIT patients than in non-HIT patients (17/20 (85%) versus 7/20 (35%); chi-square p=0.001). CONCLUSION: In critically ill patients with HIT, the incidence of thromboembolic complications and hemorrhagic complications was remarkably high.

PMID: 15156309 [PubMed - indexed for MEDLINE]