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Akuter Extremitäten-Arterienverschluss pp 69–77Cite as

Zur Problematik des akuten arteriellen Verschlusses als Folge einer heparininduzierten Thrombozytopenie

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Part of the book series: Berliner Gefäβchirurgische Reihe ((BERLINGEFÄß,volume 7))

Summary

Heparin-induced vascular ocdusion is a rare but severe adverse effect of heparin treatment. In our dinic, this disease was initially misinterpreted in 10 of 13 patients. Although complications had been induced, the heparin dosage was further increased in these cases. In addition to dinical suspicion, diagnosis of heparininduced complications is based on regular measurement of platelet count. The following laboratory tests can confirm the diagnosis: aggregation test, serotonin-release test, heparin-induced platelet release (HIP A) test, and platelet factor lVIheparin enzyme-linked immunosorbent assay test (ELISA). In one of our cases, the HIPA test gave false-negative results. A positive cross re action with low-molecular-weight heparin was found in all cases, and in six cases (46 %) there was a positive cross reaction with the heparinoid danaproid-sodium (Orgaran). Anticoagulation treatment with hirudin or danaproid sodium was given to five patients, in conjunction with vasculosurgical reconstruction. Three of these patients died and other two required amputation.

Zusammenfassung

Ein heparininduzierter GefäßBverschluss ist eine seltene aber schwere Nebenwirkung der Heparingabe. Dieser Zusammenhang wurde initial bei 10 von 13 Patienten in dem von uns untersuchten Krankengut verkannt. Obwohl bereits Komplikationen eingetreten waren, wurde die Heparindosis in diesen Fällen weiter erhoht. Neben einem klinisch begründeten Verdacht basiert die Diagnose auf regelmaBigen Kontrollen der Thrombozytenzahlen. Zur Sicherung des Verdachts konnen der Aggregationstest, der Serotonin Freisetzungstest, der heparininduzierte Plättchenaktivierungs (HIPA)-Test und der Plattchenfaktor IV/ Heparin-Immunassay (ELISA) verwendet werden. Bei einem unserer Patienten zeigte der HIPA-Test ein falsch negatives Ergebnis. Eine positive Kreuzreaktion mit niedermolekularen Heparinen fanden wir in allen Untersuchungen. Auch bei sechs Kranken (46 %) bestand eine positive Kreuzreaktion mit dem Heparinoid Danaproid-Natrium (Orgaran). Neben der gefäßchirurgischen Revaskularisation wurde bei fünf Patienten die medikamentöse Antikoagulation mit Hirudin oder Danaproid-Natrium dürchgefiihrt. Insgesamt verstarben drei Patienten und zwei weitere mussten amputiert werden.

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Authors and Affiliations

  1. Klinik für Chirurgie, Otto-von-Guericke-Universität, Magdeburg

    Th. Burger, J. Tautenhahn & Z. Halloul

Authors
  1. Th. Burger
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  2. J. Tautenhahn
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  3. Z. Halloul
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Editors and Affiliations

  1. Fachbereich Gefäβchirurgie Vaskuläre und Endovaskuläre Chirurgie, St. Josef-Krankenhaus, Robert-Koch-Straβe 16, Haan, 42781

    Wolfgang Hepp

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© 2002 Springer-Verlag Berlin Heidelberg

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Burger, T., Tautenhahn, J., Halloul, Z. (2002). Zur Problematik des akuten arteriellen Verschlusses als Folge einer heparininduzierten Thrombozytopenie. In: Hepp, W. (eds) Akuter Extremitäten-Arterienverschluss. Berliner Gefäβchirurgische Reihe, vol 7. Steinkopff, Heidelberg. https://doi.org/10.1007/978-3-642-57529-7_9

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  • DOI: https://doi.org/10.1007/978-3-642-57529-7_9

  • Publisher Name: Steinkopff, Heidelberg

  • Print ISBN: 978-3-642-63287-7

  • Online ISBN: 978-3-642-57529-7

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