| Neurocritical care | Rare Neurological Diseases  

An ignored rare condition in neurointensive unit; heparin induced thrombocytopenia

Heparin-induced thrombocytopenia (HIT) is a rare but very important condition characterized by a sudden decrease in the platelet count of more than 50% from the highest platelet count following heparin treatment

Heparin-induced thrombocytopenia (HIT) is a rare but very important condition characterized by a sudden decrease in the platelet count of more than 50% from the highest platelet count following heparin treatment. The sitution usually includes hypercoagulability, and the presence of heparin-dependent, platelet-activating IgG antibodies. Anti-protamine/heparin and anti-PF4/heparin antibody tests may be helpful and should be ordered only if clinical features reasonably suggest HIT.

The urgent cessation of heparin and the initiation of therapeutic-dose anticoagulation with an alternative agent (argatroban, danaparoid, fondaparinux, or bivalirudin) have been suggested for the treatment of HIT. Treatment with intravenous immunoglobulin G has been reported as a succesful approach. Another important point is that warfarin also should be avoided in patients with acute HIT.

This serious and life threatining autoimmune condition, must be considered for early diagnosis and prompt treatment in the patients who treated with heparin in neurointensive care units.

Heparin-induced thrombocytopenia, neurointensive care, thrombosis, heparin

 

  1. East JM, Cserti-Gazdewich CM, Granton JT. Heparin-Induced Thrombocytopenia in the Critically Ill Patient. Chest. 2017 Dec 16. pii: S0012-3692(17)33223-3. doi:  10.1016/j.chest.2017.11.039. [Epub ahead of print] Review. PubMed PMID: 29253554.
     
  2. Lee GM, Joglekar M, Kuchibhatla M, Khandelwal S, Qi R, Rauova L, Arepally GM.  Serologic characterization of anti-protamine/heparin and anti-PF4/heparin antibodies. Blood Adv. 2017 Apr 18;1(11):644-651. doi: 10.1182/bloodadvances.2017004408. eCollection 2017 Apr 25. PubMed PMID: 29296706; PubMed Central PMCID: PMC5727817.
     
  3. McKenzie DS, Anuforo J, Morgan J, Neculiseanu E. Successful Use of Intravenous Immunoglobulin G to Treat Refractory Heparin-Induced Thrombocytopenia With Thrombosis Complicating Peripheral Blood Stem Cell Harvest. J Investig Med High Impact Case Rep. 2018 Jan29;6:2324709618755414. doi: 10.1177/2324709618755414. eCollection 2018 Jan-Dec. PubMed PMID: 29404376; PubMed Central PMCID: PMC5791472.

 

Back