Abstract
In clinical use for over 50 years, heparin is an important and widely used anticoagulant for the prophylaxis or treatment of thromboembolic disease as well as other numerous clinical situations. Ordinarily, heparin prevents clotting and does not affect the platelets, components of the blood that help to form blood clots. However, heparin can also cause heparin-induced thrombocytopenia. Two distinct types of heparin-induced thrombocytopenia can occur: nonimmune and immune mediated. Nonimmune heparin-induced thrombocytopenia, which occurs most frequently, is characterized by a mild decrease in the platelet count and is not harmful. The second type, immune-mediated heparin-induced thrombocytopenia, occurs much less frequently but is dangerous. Immune-mediated heparin-induced thrombocytopenia causes much lower platelet count. Paradoxically, despite a very low platelet count, patients who suffer from heparin-induced thrombocytopenia are at risk for arterial or venous thrombosis. In this review article, there are discussed about pathogenesis of heparin-induced thrombocytopenia, other causes of thrombocytopenia, clinical features, laboratory confirmation of diagnosis, and management of patients (direct thrombin inhibitors, other therapies, duration of therapy, and use of oral anticoagulants). Prognosis and prophylaxis of this life-threatening disorder, which can develop from the use of unfractionated or (less commonly) low-molecular-weight heparin, are also discussed.
Highlights
Despite a very low platelet count, patients who suffer from heparin-induced thrombocytopenia are at risk for arterial or venous thrombosis
There are discussed about pathogenesis of heparin-induced thrombocytopenia, other causes of thrombocytopenia, clinical features, laboratory confirmation of diagnosis, and management of patients
Prognosis and prophylaxis of this life-threatening disorder, which can develop from the use of unfractionated or low-molecular-weight heparin, are discussed
Summary
Dagmara Reingardienė Kauno medicinos universiteto Intensyviosios terapijos klinika. Raktažodžiai: heparinas, mažos molekulinės masės heparinas, heparino sukelta trombocitopenija, trombocitai, trombozė, antikoaguliacija. Jos metu žymiai sumažėja trombocitų ir nepaisant to, ligoniams gresia arterinės ar veninės trombozės. Išimtis – tik ligoniai po širdies persodinimo, vartojantiems heparino HIT pasireiškia 11 proc. Ir daugiau nuo buvusio iki gydymo heparinais jų kiekio – tai įvyksta daugiau kaip 95 proc. Trombocitų gali likti ir >150×109/l (kiekis vertinamas kaip normalus), bet tiems ligoniams bus stebimas 50 proc. Ir arterinės trombozės ar net abiejų rūšių vienam ligoniui, tai kaip praeinanti įgyta trombofilija Arterinės ar veninės trombozės atveju visada reiktų prisiminti ir uždelstos eigos HIT, ypač ligoniams, kurie prieš tai (prieš kelias dienas ar net prieš 3 savaites) vartojo heparinų. Ypač sunkios būklės ligoniams trombocitopenija dažna [28, 29]: trombocitų 1 proc. Trombocitų skaičiaus kraujyje tyrimai Trombocitai tiriami prieš gydymą ir pakartotinai 24 val. laikotarpiu nuo gydymo heparinais pradžios
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