Thrombosis during the use of the heparinoid Organon 10172 in a patient with heparin-induced thrombocytopenia.

Abstract

Heparin-induced thrombocytopenia (HIT) and thrombosis is characterized by a progressive thrombocytopenia that most often occurs after 5-10 days of heparin exposure. Patients with a history of HIT requiring anti-coagulation for cardiopulmonary bypass (CPB) may face devastating consequences unless alternative anticoagulants are used. Management options have included postponing surgery until a time at which the antibody has disappeared and the patient's platelets no longer aggregate after exposured to heparin. Alternative pharmacologic means of anticoagulation include the use of low molecular weight heparin (LMWH), ancrod, warfarin, platelet inhibitors, hidudin or argatroban. 1-4 In addition, other drugs with antiplatelet activity, such as the prostacyclin analogue, iloprost, have been administered before heparin administration in an attempt to prevent platelet aggregation. The investigational heparinoid, ORG 10172 (Organon International, The Netherlands), derived from porcine intestinal mucosa, is composed of a heterogeneous mixture of dermatan sulfate, and chondroitin sulfate. This heparinoid has been an effective anticoagulant for CPB in dogs 6 and has also been used successfully as an antithrombotic agent in patients with HIT. 7 Patients with HIT have decreased antibody cross reactivity with ORG 10172. In humans, case reports have been presented by Doherty et al. 8 and Rowlings et al. 9 in which ORG 10172 was used as the anticoagulant for CPB. In this report, we describe thrombosis that occurred in a patient with HIT receiving ORG 10172 during CPB