Heparininduced thrombocytopenia in patients with venous thromboembolic complications – clinical cases and review of the literature

Abstract

Severe thrombocytopenia significantly (at times and dozens of times) increases in-hospital mortality, especially for General surgical, vascular, orthopedic and traumatological patients in comparison with cardiosurgery and interventional cardiac patients. Heparin-induced thrombocytopenia is immune-mediated complication, paradoxically accompanied by frequent thrombosis. The risk of thrombosis varies from 30–50% for moderate and up to 90% in severe thrombocytopenia. Venous thrombosis predominate over the arterial, especially thrombosis of deep veins of lower extremities and pulmonary thromboembolia. Strokes, acute myocardial infarction, thrombosis of the mesenteric, vertebral arteries, central catheters are also not rare. The delay in diagnosis and in cessation of the heparins, the use of tromboconcentrate, not appointment of alternative anticoagulants – all of it worsen prognosis and increase mortality. Currently, in order to assess the possibility of Heparin-induced thrombocytopenia «Scale 4 T» is often in usage. It contains inaccuracies and provides 4 criteria and 3 degrees, that to some extent complicates its use. In early 2014, on the basis of literature analysis and own experience, we have developed a simplified «Rule» for the rapid diagnosis of this condition. Key points are highlighted in review regarding the pathophysiology, epidemiology, diagnosis, aspects of modern management, as well as the economic impact of heparin-induced thrombocytopenia and clinical examples in surgical patients confirmed by immunoassay. The next message will show a 3-year analysis of the incidence, causes, dynamics of outcomes in a multidisciplinary hospital, and the results of the implementation of the original «Rule».

Keywords

• thrombocytopenia
• heparins
• heparin-induced thrombocytopenia (hit)
• immunodiagnostics
• thrombosis