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Heparin-induzierte Thrombozytopenien unter nichtfraktioniertem Heparin

Heparin-induced thrombocytopenia in patients treated with unfractionated heparin. A prospective clinical trial of the incidence in patients with internal diseases in hospital

Eine prospektive Studie bei stationär behandelten internistischen Patienten

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Zusammenfassung

□ Ziel

Die vorliegende Untersuchung wurde vorgenommen, um den Einfluß stationär verabreichten unfraktionierten Heparins bei der Entstehung der lebensbedrohenden Heparin-induzierten Thrombozytopenie (HIT) Typ II zu überprüfen.

□ Patienten und Methode

An 162 stationär behandelten internistischen Patienten, die aus therapeutischen oder prophylaktischen Gründen unfraktioniertes Heparin (Heparin-Natrium, Heparin-Calcium) erhielten, wurde in einer prospektiven Studie die Häufigkeit des Auftretens einer HIT Typ I und II untersucht. 55,6% der Patienten waren Frauen (n=90) mit einem durchschnittlichen Alter von 76,5 Jahren (25 bis 96 Jahre), 44,4% Männer (n=72) mit einem Durchschnittsalter von 67,5 Jahren (17 bis 93 Jahre). Dazu wurden Thrombozytenzahlen regelmäßig vor Beginn der Heparinbehandlung, am ersten Tag danach und vom fünften Tag an regelmäßig jeden zweiten Tag bis zum 20. Heparinbehandlungstag bestimmt. Bei Verdacht auf eine HIT-Typ-II-Erkrankung wurde ein HIPA-Test durchgeführt.

□ Ergebnisse

Eine HIT Typ I trat in 10%, eine HIT Typ II in 3% auf. Zwei der fünf Patienten mit einer HIT Typ II entwickelten gravierende thrombotische Komplikationen.

□ Schlußfolgerung

Aufgrund der Häufigkeit dieser Erkrankung muß eine regelmäßige Thrombozytenkontrolle bei jeder Heparintherapie durchgeführt werden.

Abstract

□ Aim

To investigate the influence of unfractionated heparin on heparin-induced thrombocytopenia (HIT) type II.

□ Patients and Method

In 162 patients with internal diseases treated therapeutically or prophylactically with unfractionated heparin (heparin sodium, heparin calcium), we carried out a prospective study to determine the incidence of HIT type I and II. 55.6% of the patients were female (n=90) with an average age of 76.5 years (range: 25 to 96 years) and 44.4% male (n=72) with an average age of 67.5 years (range: 17 to 93 years). A platelet count was taken regularly before the start of heparin treatment, on the first day of treatment and then every second day from day 5 to 20. Whenever HIT II was suspected, an HIPA test was performed.

□ Result

Type I HIT occurred in 10%, type II in 3% of the cases. Two of the 5 patients with type II developed severe thrombotic complications.

□ Conclusion

In view of the high incidence of HIT, regular platelet counts should always be carried out in patients receiving heparin treatment.

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Literatur

  1. Amiral J, Bridey F, Wolf M et al. Antibodies to macromolecular platelet factor 4-heparin complexes in heparin-induced thrombocytopenia: a study of 44 cases. Thromb Haemost 1995;73:21–8.

    PubMed  CAS  Google Scholar 

  2. Bauriedel G, Gerbig H, Riess H, Samtleben W, Steinbeck G. Heparin-induzierte Thrombozytopenie. MMW 1988;130:133–4.

    Google Scholar 

  3. Chong BH, Berndt MC. Heparin-induced thrombocytopenia. Blut 1989;58:53–7.

    Article  PubMed  CAS  Google Scholar 

  4. Chong BH, Fawaz I, Chesterman CN, Berndt MC. Heparin-induced thrombocytopenia. Mechanism of interaction of the heparin-dependent antibody with platelets. Brit J Haematol 1989;73:235–40.

    Article  CAS  Google Scholar 

  5. Chong BH, Pilgrim RL, Cooley MA, Chesterman CN. Increased expression of platelet IgG Fc receptors in immune heparin-induced thrombocytopenia. Blood 1993;81:988–93.

    PubMed  CAS  Google Scholar 

  6. Curtis JJ, Walls, JT, Goss CF, Boley TM, Sliver D. Persistence of heparin-dependent antiplatelet antibody. Int J Angiol 1996;5:201–3.

    Article  Google Scholar 

  7. Garcia S, Cervero A, Sanchez M, Colomina P. Heparin-associated thrombocytopenia in a patient with polycythemia vera. The importance of a marked drop in platelet count. Acta Haematol 1991;85:169–170.

    Article  PubMed  CAS  Google Scholar 

  8. Greinacher A. Heparin-induzierte Thrombozytopenie. Internist 1996;37:1172–8.

    PubMed  CAS  Google Scholar 

  9. Greinacher A, Amiral J, Dummel V, Vissac AM, Kiefel V, Müller-Eckhardt C. Laboratory diagnosis of heparin-associated thrombocytopenia, comparison of platelet activation (HIPA) test, and PF4/heparin ELISA. Transfusion 1994;34:381–5.

    Article  PubMed  CAS  Google Scholar 

  10. Greinacher A, Michels I, Kiefel V, Müller-Eckhardt C. A rapid and sensitiv test for diagnosing Heparin-associated thrombocytopenia. Thromb Haemostas 1991;66:734–6.

    CAS  Google Scholar 

  11. Greinacher A, Michels I, Müller-Eckhardt C. Heparin-associated thrombocytopenia. The antibody is not heparin specific. Thrombos Haemost 1992;67:545–9.

    CAS  Google Scholar 

  12. Greinacher A, Müller-Eckhardt C. Diagnostik der Heparin-assoziierten Thrombozytopenie. Dtsch Med Wochenschr 1991;116:1479–82.

    Article  PubMed  CAS  Google Scholar 

  13. Hach-Wunderle V, Kainer K, Krug B, Müller-Berghaus G, Poetzsch B. Heparin-associated thrombosis despite normal platelet counts letter. Lancet 1994;344:469–70.

    PubMed  CAS  Google Scholar 

  14. Hirsh J. Low molecular weight heparin. Thromb Haemost 1993;70:204–7.

    PubMed  CAS  Google Scholar 

  15. Hobbensiefken G, Driller B, Studtmann V, Kunz K, Lehrbach G. Heparininduzierte Thrombozytopenie Typ II (HIT II). Unfallchirurgie 1996;22:248–52.

    PubMed  CAS  Google Scholar 

  16. Horne MK, Alkins BR. Platelet binding of IgG from patients with heparin-induced thrombocytopenia. J Lab Clin Med 1996;127:418–9.

    Article  Google Scholar 

  17. Horsewood P, Warkentin TS, Hayward CP, Kelton JG. The epitope specificity of heparin-induced thrombocytopenia. Br J Haematol 1996;95:161–7.

    Article  PubMed  CAS  Google Scholar 

  18. Kahl K, Heidrich H. The incidence of heparin-induced thrombocytopenia. Intern J Angiol 1998; in press.

  19. Kappers-Klunne MC, Boon DMS, Hop WCJ et al. Heparin-induced thrombocytopenia and thrombosis: a prospective analysis of the incidence in patients with heart and cerebrovascular diseases. Br J Hematol 1997;96:442–6.

    Article  CAS  Google Scholar 

  20. Kelton JG, Smith JW, Warkentin TE, Hayward CPM, Denomme G, Horsewood P. IgG from patients with heparin-induced thrombocytopenia bind to a complex of heparin and platelet factor 4. Blood 1994;83:3232–9.

    PubMed  CAS  Google Scholar 

  21. King DJ, Kelton JG. Heparin associated thrombocytopenia. Ann Intern Med 1984;100:535–40.

    PubMed  CAS  Google Scholar 

  22. Krauss T, Rath W, Dittmer U, Kuhn W. Thromboembolieprophylaxe mit niedermolekularem Heparin (Fragmin) in der Geburtshilfe. Z Geburtshilfe Perinatol 1994;198:120–5.

    PubMed  CAS  Google Scholar 

  23. Magnani HN. Heparin-induced thrombocytopenia (HIT): an overview of 230 patients treated with Orgaran (Org 10172). Thromb Haemost 1993;70:554–61.

    PubMed  CAS  Google Scholar 

  24. Singer RL, Mannion JD, Bauer TL, Armenti FR, Edie RN. Complications from heparin-induced thrombocytopenia in patients undergoing cardiopulmonary bypass. Chest 1993;104:1436–40.

    Article  PubMed  CAS  Google Scholar 

  25. Spadone D, Clark F, James E, Laster J, Hoch J, Silver D. Heparin-induced thrombocytopenia in the newborn. J Vasc Surg 1992;15:306–12.

    Article  PubMed  CAS  Google Scholar 

  26. Suh JS, Malik MI, Aster RH, Visentin GP. Characterization of the humoral immune response in heparin-induced thrombocytopenia. Am J Hematol 1997;54:196–201.

    Article  PubMed  CAS  Google Scholar 

  27. Towe JB, Bernhard VM, Hussey C, Garancis JC. White clost syndrome. Arch Surg 114 (1979), 372–377.

    Google Scholar 

  28. Walls JT, Curtis JJ, Silver D, Boley TM. Heparin-induced thrombocytopenia in patients who undergo open heart surgery. Surgery 1990;108:686–92.

    PubMed  CAS  Google Scholar 

  29. Warkentin TE, Levine MN, Hirsh J et al. Heparin-induced thrombocytopenia in patients treated with low molecular weight heparin or unfractionated heparin. N Engl J Med 1995;322:1330–5.

    Article  Google Scholar 

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Authors and Affiliations

  1. Innere Abteilung des Franziskus-Krankenhaus Berlin, Budapester Straße 15-19, D-10787, Berlin

    Heinz Heidrich (Chefarzt der Inneren Abteilung, Ärztlicher Direktor), Karen Kahl, Christine Penninger, Bojana Bechstein, Manuela Birkenmaier, Susanne Dressler, Clemens Fahrig, Jens Helmis, Georg Herman, Ursula von Knobloch, Marianne Ladleif, Katharina Meier, Marco Rudolph, Burckhard Schlich, Matthias Wanke & Birgit Zwernemann

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  1. Heinz Heidrich
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Heidrich, H., Kahl, K., Penninger, C. et al. Heparin-induzierte Thrombozytopenien unter nichtfraktioniertem Heparin. Med Klin 93, 343–346 (1998). https://doi.org/10.1007/BF03044677

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  • DOI: https://doi.org/10.1007/BF03044677

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