Biological and clinical features of low-molecular-weight heparin-induced thrombocytopenia

被引:79
作者
Gruel, Y
Pouplard, C
Nguyen, P
Borg, JY
Derlon, A
Juhan-Vague, I
Regnault, V
Samama, M
机构
[1] Tours Lab Hematol Hemostase, Tours, France
[2] Reims Lab Hematol Hemostase, Reims, France
[3] Rouen Lab Hematol Hemostase, Rouen, France
[4] Caen Lab Hematol Hemostase, Caen, France
[5] Marseille Lab Hematol Hemostase, Marseille, France
[6] Vandoeuvre Nancy Lab Hematol Hemostase, Vandoeuvre Les Nancy, France
[7] Paris Lab Hematol Hemostase, Paris, France
关键词
low-molecular-weight heparin; unfractionated heparin; thrombosis; thrombocytopenia; platelet factor 4;
D O I
10.1046/j.1365-2141.2003.04363.x
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Heparin-induced thrombocytopenia (HIT) is a common adverse effect of unfractionated heparin (UFH) therapy. In contrast, only a few patients have been reported with HIT following low-molecular-weight heparin (LMWH) therapy (LMW-HIT). To define the clinical and biological characteristics of LMW-HIT, 180 patients treated for suspected HIT at 15 French centres were investigated. Clinical history was recorded and HIT was confirmed in 59 patients with positive serotonin release assay results: 57 of them had high levels of antibodies (Abs) to heparin-platelet factor 4 complexes (H/PF4) and two had Abs to interleukin 8. Eleven patients were treated exclusively with LMWH (LMW-HIT) and 48 with UFH either alone (UF-HIT, n = 34) or combined with LMWH (UF/LMW-HIT, n = 14). The LMW-HIT and UF-HIT groups were similar with respect to sex, age, platelet count before heparin therapy, frequency of bleeding and occurrence of disseminated intravascular coagulation. The interval to onset of HIT was longer in LMW-HIT patients compared with UF-HIT patients (P = 0.03). Severe thrombocytopenia (platelets < 15 x 10(9)/l) was more frequent in the LMW-HIT group (P = 0.04). Thrombosis occurred in three of 11 LMW-HIT patients, i.e. as frequently as in UF-HIT patients. LMW-HIT is potentially severe and may be observed after longer heparin treatment compared with UF-HIT. It is highly recommended, therefore, that platelet counts be monitored carefully whenever LMWH is administered.
引用
收藏
页码:786 / 792
页数:7
相关论文
共 27 条
[1]  
Amiral J, 1996, AM J HEMATOL, V52, P90, DOI 10.1002/(SICI)1096-8652(199606)52:2<90::AID-AJH4>3.3.CO
[2]  
2-5
[3]   Presence of autoantibodies to interleukin-8 or neutrophil-activating peptide-2 in patients with heparin-associated thrombocytopenia [J].
Amiral, J ;
MarfaingKoka, A ;
Wolf, M ;
Alessi, MC ;
Tardy, B ;
BoyerNeumann, C ;
Vissac, AM ;
Fressinaud, E ;
Poncz, M ;
Meyer, D .
BLOOD, 1996, 88 (02) :410-416
[4]  
AMIRAL J, 1995, THROMB HAEMOSTASIS, V73, P21
[5]   Heparin-induced thrombocytopenia:: New insights into the impact of the FcγRIIa-R-H131 polymorphism [J].
Carlsson, LE ;
Santoso, S ;
Baurichter, G ;
Kroll, H ;
Papenberg, S ;
Eichler, P ;
Westerdaal, NAC ;
Kiefel, V ;
van de Winkel, JGJ ;
Greinacher, A .
BLOOD, 1998, 92 (05) :1526-1531
[6]   Heparin-induced thrombocytopenia with thrombotic complications during prophylactic treatment with low-molecular-weight heparin [J].
deRaucourt, E ;
Vinsonneau, C ;
Juvin, K ;
Fischer, AM ;
Meyer, G .
BLOOD COAGULATION & FIBRINOLYSIS, 1996, 7 (08) :786-788
[7]   THROMBOCYTOPENIA ASSOCIATED WITH LOW-MOLECULAR-WEIGHT HEPARIN [J].
EICHINGER, S ;
KYRLE, PA ;
BRENNER, B ;
WAGNER, B ;
KAPIOTIS, S ;
LECHNER, K ;
KORNINGER, HC .
LANCET, 1991, 337 (8754) :1425-1426
[8]   A fatal low-molecular-weight heparin-associated thrombocytopenia after hip surgery: Possible usefulness of PF4-heparin ELISA test [J].
Elalamy, I ;
Potevin, F ;
Lecrubier, C ;
Bara, L ;
Marie, JP ;
Samama, MM .
BLOOD COAGULATION & FIBRINOLYSIS, 1996, 7 (07) :665-671
[9]   HEPARIN-ASSOCIATED THROMBOCYTOPENIA - IMMUNE-COMPLEXES ARE ATTACHED TO THE PLATELET MEMBRANE BY THE NEGATIVE CHARGE OF HIGHLY SULFATED OLIGOSACCHARIDES [J].
GREINACHER, A ;
MICHELS, I ;
LIEBENHOFF, U ;
PRESEK, P ;
MUELLERECKHARDT, C .
BRITISH JOURNAL OF HAEMATOLOGY, 1993, 84 (04) :711-716
[10]   HEPARIN-ASSOCIATED THROMBOCYTOPENIA [J].
KING, DJ ;
KELTON, JG .
ANNALS OF INTERNAL MEDICINE, 1984, 100 (04) :535-540