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Heparininduzierte Thrombozytopenie

Heparin-induced thrombocytopenia

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Zusammenfassung

Die heparininduzierte Thrombozytopenie (HIT) ist eine unerwünschte Arzneimittelreaktion mit einem erhöhten Risiko für thromboembolische Komplikationen. Hervorgerufen wird die Erkrankung durch thrombozytenaktivierende Antikörper, die sich gegen einen Komplex aus Plättchenfaktor 4 (PF4) und Heparin richten. Typischerweise manifestiert sich die HIT in der 2. Woche nach Beginn einer Heparintherapie mit einem Thrombozytenabfall von mehr als 50% des höchsten Werts nach Beginn der Heparingabe sowie mit thromboembolischen Ereignissen. Die klinische Wahrscheinlichkeit kann mit dem 4-T-Score ermittelt werden. Die Labordiagnose der HIT basiert einerseits auf dem Nachweis von PF4/Heparin-Antikörpern, zum anderen kann in funktionellen Tests der Nachweis heparinabhängiger, thrombozytenaktivierender Antikörper erbracht werden. Ein niedriger 4-T-Score sowie ein negativer HIT-Test schließen eine HIT nahezu aus. Patienten mit akuter HIT benötigen eine Antikoagulation mit einem kompatiblen Antikoagulanz in therapeutischer Dosierung. Hierfür stehen derzeit die direkten Thrombininhibitoren Argatroban, Lepirudin, Bivalirudin und Desirudin zur Verfügung sowie die indirekten Faktor-Xa-Inhibitoren Danaparoid und Fondaparinux.

Abstract

Heparin-induced thrombocytopenia (HIT) is an adverse drug reaction that carries an increased risk of thromboembolic complications. HIT is caused by platelet-activating antibodies directed against a complex of platelet factor 4 (PF4) and heparin. HIT typically manifests in the second week after initiation of heparin therapy with a platelet count reduction of more than 50% of the highest level after the start of heparin administration as well as thromboembolic events. The clinical probability can be calculated by the 4 T’s score. The laboratory diagnosis of HIT is based on confirmation of PF4/heparin antibodies or on functional tests that provide evidence of heparin-dependent platelet-activating antibodies. A low 4 T’s score and negative HIT test virtually rule out the presence of HIT. Patients with acute HIT require anticoagulation with a compatible anticoagulant in a therapeutic dose. The drugs currently available for this include the direct thrombin inhibitors argatroban, lepirudin, bivalirudin, and desirudin and the indirect factor Xa inhibitors danaparoid and fondaparinux.

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  1. Institut für Immunologie und Transfusionsmedizin , Ernst-Moritz-Arndt Universität, Sauerbruchstraße, 17489, Greifswald, Deutschland

    T. Thiele, K. Althaus &  A. Greinacher

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  1. T. Thiele
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  2. K. Althaus
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  3. A. Greinacher
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Correspondence to A. Greinacher.

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Thiele, T., Althaus, K. & Greinacher, A. Heparininduzierte Thrombozytopenie. Internist 51, 1127–1135 (2010). https://doi.org/10.1007/s00108-010-2594-5

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