Treatment of Heparin-Induced Thrombocytopenia

2002 ◽  
Vol 36 (3) ◽  
pp. 489-503 ◽  
Author(s):  
William E Dager ◽  
Richard H White
Keyword(s):  
Adverse Reaction ◽  
Treatment Options ◽  
Clinical Manifestations ◽  
Low Molecular Weight ◽  
National Library ◽  
Severe Adverse Reaction ◽  
Heparin Induced Thrombocytopenia ◽  
Immune Mediated ◽  
Study Selection ◽  
Clinical Conditions

OBJECTIVE: To describe heparin-induced thrombocytopenia (HIT or HIT-2), an immune-mediated adverse reaction to heparin or low-molecular-weight heparin. Available treatment options and considerations in developing a therapy approach are discussed. DATA SOURCES: A search of the National Library of Medicine (1992–June 2001) was done to identify pertinent literature. Additional references were reviewed from selected articles. STUDY SELECTION: Articles related to laboratory recognition and treatment options of HIT, including the use of agents in selected clinical conditions, were reviewed and included. CONCLUSIONS: HIT is a rare but potentially severe adverse reaction to heparin that was, until recently, poorly understood and had limited treatment options. Recent advances describing the recognition and clinical manifestations of immune-mediated HIT, including recently available antithrombotic treatment options, have dramatically changed outcomes for patients having this syndrome.

scholarly journals Fondaparinux-associated Thrombocytopenia

2021 ◽  
Vol 37 (2) ◽  
Author(s):  
Jahanzeb Malik ◽  
Nismat Javed ◽  
Matiullah Kamin
Keyword(s):  
Molecular Weight ◽  
Open Access ◽  
Low Molecular Weight Heparin ◽  
Original Work ◽  
Low Molecular Weight ◽  
Heparin Induced Thrombocytopenia ◽  
Creative Commons ◽  
Immune Mediated ◽  
Open Access Article

Heparin-induced thrombocytopenia (HIT) is an immune-mediated condition causing thrombocytopenia and paradoxical thrombosis after exposure to heparin or low-molecular-weight heparin. It has been rarely reported by Fondaparinux, an artificial pentasaccharide similar to heparin. This manuscript presents a case of HIT associated with fondaparinux use. doi: https://doi.org/10.12669/pjms.37.2.3522 How to cite this:Malik J, Javed N, Kamin M. Fondaparinux-associated Thrombocytopenia. Pak J Med Sci. 2021;37(2):---------. doi: https://doi.org/10.12669/pjms.37.2.3522 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Immune-Mediated Disease of the Neuromuscular Junction

2019 ◽  
pp. 130-176
Author(s):  
Robert P. Lisak ◽  
James Selwa
Keyword(s):  
Neuromuscular Junction ◽  
Myasthenia Gravis ◽  
Rare Disease ◽  
Treatment Options ◽  
Clinical Manifestations ◽  
Diagnosis And Treatment ◽  
Future Directions ◽  
Immune Mediated ◽  
Myasthenic Syndrome

The chapter is concerned with disorders that affect the neuromuscular junction (NMJ). Myasthenia gravis (MG) is a prototypic antibody-mediated disease affecting the neuromuscular junction. The chapter looks at the epidemiology of MG. It also considers clinical manifestations and presentations, classification and staging, and diagnosis. The chapter also examines immunologic testing and issues such as pregnancy in MG. It considers future directions and treatment options in this area. Next, the chapter considers Lambert Eaton myasthenic syndrome (LEMS), which is a rare disease of the NMJ that is difficult to diagnose. The chapter looks at clinical manifestations, diagnosis, and treatment. Finally, the chapter briefly considers other immune-mediated diseases.

scholarly journals Injection Site Erythema in a Patient on Therapeutic Anticoagulation with Low Molecular Weight Heparin after Mechanical Aortic Valve Replacement: A Rare Presentation of Heparin- and Protamine-Induced Thrombocytopenia

2020 ◽  
Vol 2020 ◽  
pp. 1-3 ◽  
Author(s):  
Caroline Holaubek ◽  
Paul Simon ◽  
Sabine Eichinger-Hasenauer ◽  
Franz Gremmel ◽  
Barbara Steinlechner
Keyword(s):  
Skin Necrosis ◽  
Clinical Presentation ◽  
Clinical Symptoms ◽  
Clinical Manifestations ◽  
Low Molecular Weight ◽  
Igg Antibodies ◽  
Rare Presentation ◽  
Platelet Factor ◽  
Heparin Induced Thrombocytopenia ◽  
Therapeutic Anticoagulation

Previous exposition to heparin and protamine in patients undergoing cardiopulmonary bypass and postoperative therapeutic anticoagulation with LMWH may lead to the development of heparin-induced thrombocytopenia (HIT) and/or protamine-induced thrombocytopenia (PIT). This case deals with a rare clinical presentation of circulating IgG antibodies against heparin/platelet factor 4 complexes and heparin/protamine complexes after cardiac surgery. Ensuing purpura and skin necrosis (blisters) at the injection sites of LMWH and clinical symptoms improved rapidly after replacement of LMWH by an alternative anticoagulant. The aim of this report is to draw attention to the several different clinical manifestations of heparin- and/or protamine-induced thrombocytopenia and shows a possible course of treatment and recovery.

Drug-Induced Immune Thrombocytopenia

2014 ◽  
Vol 27 (5) ◽  
pp. 430-439 ◽  
Author(s):  
Teresa Kam ◽  
Maurice Alexander
Keyword(s):  
Data Collection ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Immune Thrombocytopenia ◽  
Treatment Options ◽  
Diagnosis And Treatment ◽  
Drug Induced ◽  
Laboratory Findings ◽  
Heparin Induced Thrombocytopenia ◽  
Immune Mediated

Thrombocytopenia is commonly seen in laboratory findings, especially in critically ill patients. Although the incidence is rare, drug-induced immune thrombocytopenia (DITP) is a serious complication that is often overlooked as a cause of thrombocytopenia. Over the last century, extensive research and data collection have been done in an attempt to better characterize DITP. Heparin-induced thrombocytopenia is the most common DITP and has distinct pathogenesis, diagnosis, and treatment options. However, other offending medications are less well known and have triggered many questions and constant search for answers. This review will discuss both drug-induced immune-mediated and nonimmune-mediated thrombocytopenias, with a focus on immune-mediated processes. Thrombocytopenia caused by chemotherapy will not be discussed in this article.

scholarly journals IS THE INCIDENCE TREND OF HEPARIN-INDUCED THROMBOCYTOPENIA DECREASED BY THE INCREASED USE OF LOW-MOLECULAR-WEIGHT-HEPARIN?

2015 ◽  
Vol 7 ◽  
pp. e2015029 ◽  
Author(s):  
Fahad Al-Eidan
Keyword(s):  
Molecular Weight ◽  
Retrospective Study ◽  
Unfractionated Heparin ◽  
Low Molecular Weight Heparin ◽  
Adult Patients ◽  
Enzyme Linked Immunosorbent Assay ◽  
Low Molecular Weight ◽  
Heparin Induced Thrombocytopenia ◽  
Immune Mediated ◽  
Increasing Trend

Background: The increasing trend of using low-molecular-weight-heparin (LMWH) versus unfractionated heparin (UFH) in hospitalized adult patients is raising concerns about the incidence of heparin-induced thrombocytopenia (HIT). Method: A retrospective study analyzed the requests for heparin-induced antibodies by enzyme-linked immunosorbent assay (ELISA) among adult hospitalized patients during the period from January 2011 to December 2013. These patients received either UFH or LMWH for prevention or therapeutic indications. Those with positive immune-mediated HIT were identified and considered as case patients. Result: The usage of LMWH and UFH and development of HIT was determined during the study period. The incidence of HIT in patients receiving UFH and those receiving LMWH was 4.09 per thousand patients and 0.48 per thousand patients, respectively, (p<0.0001) with an overall incidence of 2.49 per thousand patients. Conclusion: The increased trend of using LMWH over UFH among hospitalized adult patients was observed and can be said to contribute to the diminished overall incidence of HIT.

Review: Recent Advances in Argatroban-Warfarin Transition in Patients With Heparin-induced Thrombocytopenia

2008 ◽  
Vol 16 (1) ◽  
pp. 5-12 ◽  
Author(s):  
Ziad Taimeh ◽  
Babette Weksler
Keyword(s):  
Active Site ◽  
Thrombin Inhibitors ◽  
Direct Thrombin Inhibitors ◽  
Low Molecular Weight ◽  
Heparin Induced Thrombocytopenia ◽  
Prevention Of Thrombosis ◽  
Immune Mediated ◽  
Life Threatening ◽  
Comprehensive Manner ◽  
Synthetic Molecule

Heparin-induced thrombocytopenia is a devastating, life-threatening, immune-mediated complication of therapy with unfractionated heparin, and less frequently, with low molecular weight heparin. Direct thrombin inhibitors are now standard therapy for the prevention of thrombosis in heparin-induced thrombocytopenia. Argatroban, a small synthetic molecule that inhibits thrombin at its active site, is increasingly used as the direct thrombin inhibitors of choice. Transition to longer term oral anticoagulation needs to be instituted after the platelet count has risen, because of the persistent risk of thrombosis. Although guidelines available in the literature outline the management of heparin-induced thrombocytopenia, they are not presented in a concise and comprehensive manner easily followed by physicians. This article reviews current recommendations, relevant studies, and clinical management trials carried out on patients with heparin-induced thrombocytopenia and provides updated, detailed guidelines for treatment of heparin-induced thrombocytopenia with emphasis on a key part of the management, the argatroban—warfarin transition.

Using Naïve Bayes Algorithm to Estimate the Response to Drug in Lung Cancer Patients

2019 ◽  
Vol 21 (10) ◽  
pp. 734-748 ◽  
Author(s):  
Baoling Guo ◽  
Qiuxiang Zheng
Keyword(s):  
Lung Cancer ◽  
Side Effects ◽  
Cancer Patients ◽  
Drug Response ◽  
Treatment Options ◽  
Clinical Manifestations ◽  
Treatment Strategies ◽  
Cancer Resistance ◽  
Lung Cancer Patients ◽  
Bayes Algorithm

Aim and Objective: Lung cancer is a highly heterogeneous cancer, due to the significant differences in molecular levels, resulting in different clinical manifestations of lung cancer patients there is a big difference. Including disease characterization, drug response, the risk of recurrence, survival, etc. Method: Clinical patients with lung cancer do not have yet particularly effective treatment options, while patients with lung cancer resistance not only delayed the treatment cycle but also caused strong side effects. Therefore, if we can sum up the abnormalities of functional level from the molecular level, we can scientifically and effectively evaluate the patients' sensitivity to treatment and make the personalized treatment strategies to avoid the side effects caused by over-treatment and improve the prognosis. Result & Conclusion: According to the different sensitivities of lung cancer patients to drug response, this study screened out genes that were significantly associated with drug resistance. The bayes model was used to assess patient resistance.

scholarly journals Dual threat of comorbidity of celiac disease and systemic lupus erythematosus

2021 ◽  
Vol 49 (5) ◽  
pp. 030006052110122
Author(s):  
Yimin Ma ◽  
Duanming Zhuang ◽  
Zhenguo Qiao
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Celiac Disease ◽  
Lupus Erythematosus ◽  
Clinical Manifestations ◽  
Failure To Thrive ◽  
Severe Malnutrition ◽  
Systemic Lupus ◽  
Electrolyte Disorders ◽  
Diagnostic Challenge ◽  
Immune Mediated

Celiac disease (CD) is a chronic immune-mediated intestinal disease that is characterized by production of autoantibodies directed against the small intestine. The main clinical manifestations of CD are typically defined as those related to indigestion and malabsorption. These manifestations include unexplained diarrhea or constipation, abdominal pain, bloating, weight loss, anemia, failure-to-thrive in children, and decreased bone density. Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by heterogeneous clinical manifestations, which may also involve the gastrointestinal tract. Comorbidity of CD and SLE is rare, and the overlapping symptoms and nonspecific clinical presentation may pose a diagnostic challenge to clinicians. We report here a case of SLE with CD, which mainly manifested as recurrent diarrhea, uncorrectable electrolyte disorders, and severe malnutrition. Through review, we hope to further improve our understanding and diagnostic level of this combination of diseases.

scholarly journals Fondaparinux Pre-, Peri-, and/or Postpartum for the Prophylaxis/Treatment of Venous Thromboembolism (FondaPPP)

2021 ◽  
Vol 27 ◽  
pp. 107602962110145
Author(s):  
Carl-Erik Dempfle ◽  
Jürgen Koscielny ◽  
Edelgard Lindhoff-Last ◽  
Birgit Linnemann ◽  
Irene Bux-Gewehr ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Adverse Events ◽  
Drug Hypersensitivity ◽  
Low Molecular Weight ◽  
Premature Births ◽  
First Line ◽  
Bleeding Events ◽  
Heparin Induced Thrombocytopenia ◽  
First Line Therapy ◽  
Heparin Allergy

We analyzed data for women who received fondaparinux for ≥7 days during pregnancy. The study retrospectively included women who received fondaparinux pre-, peri- and/or postpartum for ≥7 days for prophylaxis/venous thromboembolism (VTE) treatment at German specialist centers (2004-2010). Data on pregnancy, VTE risk factors, anticoagulant treatment, pregnancy outcome and adverse events were extracted from medical records. 120 women (mean age 31.5 years) were included. Among 84 women with prior pregnancies, 41.0% had ≥1 abortion. Anticoagulation was indicated for prophylaxis in 92.5% cases, including 82.5% women with an elevated VTE risk (82.8% thrombophilia, 34.2% VTE history). All women received low-molecular-weight heparin (LMWH) as first-line therapy; 3 also unfractionated heparin. Treatment changed to fondaparinux, due to heparin allergy (41.7%) or heparin-induced thrombocytopenia (10.0%). Fondaparinux was generally well tolerated. Adverse events included bleeding events (n = 5), abortion (n = 2), premature births (n = 2), stillbirth (n = 1), arrested labors (n = 2), injection site erythema (n = 4) and unspecified drug hypersensitivity (n = 6). No VTE events or increased liver enzymes occurred during treatment. In this retrospective study, fondaparinux was effective and well tolerated. Trial registration: ClinicalTrials.gov NCT01004939.

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