Abstract
Purpose
To review recent developments in the pathogenesis, clinical features, laboratory testing and treatment of heparininduced thrombocytopenia (HIT).
Methods
Narrative review of the literature, including relevant papers published in English or French.
Principal findings
Although the prevalence of HIT has decreased with the widespread use of low molecular weight heparin in the past ten years, HIT remains a life-threatening prothrombotic state. This immune adverse event due to heparin-dependent antibodies that bind to chemokines (such as platelet factor 4) induces platelet activation and hypercoagulability. Heparin-induced thrombocytopenia can be complicated by thrombosis even after withdrawing heparin, explaining why substituting heparin with an alternative anticoagulant (danaparoid, lepirudin, argatroban) is always necessary. However, management of these alternative treatments is difficult, and in some patients there is the risk of withdrawing heparin without taking the time to diagnose HIT properly on the basis of clinical and laboratory findings (evolution of platelet count, laboratory testing such as antigen assays and platelet activation tests).
Conclusions
Management of HIT has become easier in recent years with the development of more specific and sensitive laboratory tests and new antithrombotic drugs. However, the diagnosis of HIT is often difficult, and it remains very important to investigate this adverse reaction systematically in every patient treated with heparin who develops thrombocytopenia.
Résumé
Objectif
Revoir ľévolution de la pathogenèse, des caractéristiques cliniques, des tests de laboratoire et du traitement de la thrombopénie induite par ľhéparine (TIH).
Méthode
Une revue descriptive de la littérature, incluant les articles pertinents publiés en anglais ou en français.
Constatations principales
Quoique la prévalence de TIH ait diminué avec ľusage répandu de ľhéparine de bas poids moléculaire au cours des dix dernières années, la TIH demeure un état prothrombotique grave. Cet événement immunitaire indésirable, causé par des anticorps reliés à ľhéparine qui se lient aux chimiokines (comme le facteur plaquettaire 4), induit ľactivation des plaquettes et ľhypercoagulabilité. La TIH peut être compliquée par une thrombose même après le retrait de ľhéparine, ce qui explique pourquoi la substitution de ľhéparine par un autre anticoagulant (danaparoïde, lépirudine, argatroban) est toujours nécessaire. Cependant, ľutilisation de ces traitements de remplacement est difficile, et chez certains patients, il y a le risque de retirer ľhéparine sans prendre le temps de diagnostiquer correctement la TIH ďaprès les signes cliniques et les résultats de laboratoire (évolution de la numération plaquettaire, tests immunologiques et fonctionnels).
Conclusion
Le traitement de la TIH est maintenant plus facile avec le développement de tests de laboratoire plus spécifiques et plus sensibles et de nouveaux médicaments antithrombotiques. Mais le diagnostic de TIH est souvent difficile à poser et il demeure très important de rechercher cette réaction indésirable de façon systématique chez chaque patient traité avec de ľhéparine chez qui se développe une thrombopénie.
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Maistre, E., Gruel, Y. & Lasne, D. Diagnosis and management of heparin-induced thrombocytopenia. Can J Anesth 53 (Suppl 2), S123–S134 (2006). https://doi.org/10.1007/BF03022259
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DOI: https://doi.org/10.1007/BF03022259