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J Thorac Cardiovasc Surg 1997;114:517-518
© 1997 Mosby, Inc.

LETTERS TO THE EDITOR

Treatment of heparin-induced thrombocytopenia

University Hospital Maastricht
Department of Internal Medicine
Division of Haematology and Oncology
Postbus 5800
6202 AZ Maastricht, The Netherlands

To the Editor:

In the November 1996 issue of the Journal (1996;112:1390-92), Ganjoo, Harloff, and Johnson reported the case of a patient with heparin-induced thrombocytopenia (HIT) treated by enoxaparin. They concluded that cardiac operations can be safely done with the use of a circuit coated with Carmeda Bioactive Surface (Medtronic, Anaheim, Calif.) in combination with low-molecular-weight heparin in patients with HIT. I would like to comment on this conclusion.

If thrombocytopenia develops as a result of heparin, the heparin infusion should be stopped immediately. It is, however, difficult to choose an alternative anticoagulant. Initial reports have described the use of low-molecular-weight heparin instead of unfractionated heparin. ¹ Recently Warkentin, ² Peters, ³ Magnani, ⁴ and their associates emphasized that low-molecular-weight heparin is not indicated for the treatment of patients with HIT because of extensive cross-reactivity (80% to 90%). Patients with HIT who were treated by the heparinoid danaparoid sodium (ORG 10172; Orgaran) had lower cross-reactivity (10%). However, before the heparinoid danaparoid sodium (ORG 10172) or eventually low-molecular-weight heparin is substituted for heparin, the plasma of the patients should be tested for cross-reactivity toward one or more of these agents (platelet aggregation or 14-seratonin release test). The alternative anticoagulant is safer if no cross-reactivity has been detected. If acute replacement of heparin is necessary, the best option is danaparoid sodium (ORG 10172). Other approaches to the treatment are not conclusive.

12/8/83416

References

1. Gouault-Heilmann M, Huet Y, Adnot S, et al. Low molecular weight heparin fractions as an alternative therapy in heparin induced thrombocytopenia. Haemostasis 1988:17;134-40.
   
2. Warkentin TE, Levine MN, Hirsch J, et al. Heparin induced thrombocytopenia in patients treated with low molecular weight heparin or unfractionated heparin. N Engl J Med 1995:332;1330-5.
   
3. Peters FPJ, Doevendans PAFM, Van Der Ent FWC, et al. Low molecular weight heparin induced thrombocytopenia and thrombosis. Eur J Haematol 1996;56:329-30. [Medline]
   
4. Magnani HN. Heparin-induced thrombocytopenia (HIT): an overview of 230 patients treated with Orgaran (ORG 10172). Thromb Haemost 1993;70:554-61.[Medline]
   

This Article Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Peters, F. P. J. Search for Related Content PubMed PubMed Citation Articles by Peters, F. P. J.