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Danaparoid cross-reactivity with heparin-induced thrombocytopenia antibodies: report of 12 cases

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Abstract

Purpose

Danaparoid is a safe and effective drug for the treatment of heparin-induced thrombocytopenia (HIT). We describe an uncommon complication: danaparoid cross-reactivity with HIT antibodies.

Design and setting

A retrospective observational multicenter study on HIT was conducted in France. In this study concerning HIT patients treated with lepirudin, 12 patients were treated with lepirudin because danaparoid cross-reacted with the heparin-dependent antibodies.

Results

Three groups of situations can be separated. In a first group, four patients received a short course of danaparoid until their initial functional HIT assay showed a cross-reactivity between danaparoid and HIT antibodies. One patient presented a fatal thrombotic complication but the relationship between this thrombotic complication and danaparoid cross-reactivity cannot be certain. In a second group, four patients received for 4 days at least a danaparoid treatment while the initial functional test did not show any danaparoid cross-reactivity. During danaparoid treatment, no significant increase of platelet count was observed and two patients presented a fatal thrombotic complication. In a third group, cross-reactivity between danaparoid and HIT antibodies was not checked before danaparoid therapy. During danaparoid treatment, no significant increase of platelet count was observed and the four patients developed a venous thromboembolic complication.

Conclusion

Absence of any increase in platelet count after 3 to 5 days of danaparoid therapy and/or the occurrence of a new thrombotic event should lead to danaparoid cross-reactivity suspicion. However, before attributing thrombotic complications to danaparoid cross-reactivity, it is crucial to verify that the patients received the recommended danaparoid dosage regimen.

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Author information

Authors and Affiliations

  1. Hemostasis Department, EA 3065, CHRU, Saint-Etienne, 42055, France

    B. Tardy-Poncet

  2. Hematology Department, AP-HP Hôpital Antoine Béclère, Clamart, France

    M. Wolf

  3. Hematology Department, AP-HP Hôpital Necker, Paris, France

    D. Lasne

  4. Hemostasis Department, CHU, Lille, France

    A. Bauters

  5. Hematology Department, Hôpital Louis Pradel, CHU, Lyon, France

    P. Ffrench

  6. Hemostasis Department, Hôpital Tenon, Paris, France

    I. Elalamy

  7. Intensive Care Unit, Inserm CIC E3, CHU, Saint-Etienne, France

    B. Tardy

Authors
  1. B. Tardy-Poncet
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  2. M. Wolf
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  3. D. Lasne
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  4. A. Bauters
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  5. P. Ffrench
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  6. I. Elalamy
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  7. B. Tardy
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Corresponding author

Correspondence to B. Tardy-Poncet.

Additional information

This study is conducted for the GEHT HIT Study Group.

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Tardy-Poncet, B., Wolf, M., Lasne, D. et al. Danaparoid cross-reactivity with heparin-induced thrombocytopenia antibodies: report of 12 cases. Intensive Care Med 35, 1449–1453 (2009). https://doi.org/10.1007/s00134-009-1464-x

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  • DOI: https://doi.org/10.1007/s00134-009-1464-x

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