Heparin Reexposure in Patients With a History of Heparin-Induced Thrombocytopenia

Prajwal Dhakal; Smith Giri; Ranjan Pathak; Vijaya Raj Bhatt

doi:10.1177/1076029615578167

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Heparin Reexposure in Patients With a History of Heparin-Induced Thrombocytopenia

Journal article

Open access

Peer reviewed

Heparin Reexposure in Patients With a History of Heparin-Induced Thrombocytopenia

Prajwal Dhakal, Smith Giri, Ranjan Pathak and Vijaya Raj Bhatt

Clinical and applied thrombosis/hemostasis, Vol.21(7), pp.626-631

10/2015

DOI: 10.1177/1076029615578167

PMID: 25804614

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Abstract

Patients with a history of heparin-induced thrombocytopenia (HIT), who require subsequent anticoagulation, have limited options. Rechallenge with unfractionated heparin (UFH) has been reported but may be associated with a risk of recurrence of HIT. The objective of this study was to determine the safety of heparin reexposure in patients with a history of HIT. Using several search terms, all cases of heparin reexposure in patients with HIT indexed in MEDLINE (English language only) by June 2014 were reviewed. The bibliography of each relevant article was searched for additional reports. In cases of multiple reexposures, each reexposure was identified as a separate instance of reexposure during analysis. A total of 136 patients with a history of HIT had 141 instances of heparin reexposure. Cardiac (76%) and vascular surgeries (11%) were the most common indications. Antiplatelet factor 4/heparin antibodies were positive in 63% of evaluable cases before reexposure. Preexposure plasma exchange (11%) and postexposure nonheparin anticoagulants (63%) were frequently utilized. Complications with heparin reexposure included recurrence of HIT (2.1%, 95% confidence interval 0.73%-6.07%) and bleeding (2.1%). Intraoperative heparin reexposure in patients with a history of HIT has a small risk of developing HIT recurrence. The use of preexposure plasma exchange in patients with positive antiplatelet factor 4/heparin antibody and postexposure nonheparin anticoagulants arguably may have reduced the risk of recurrence of HIT.

Anticoagulants - adverse effects

Anticoagulants - pharmacokinetics

Anticoagulants - therapeutic use

Cardiopulmonary Bypass

Drug Monitoring

Female

Heparin - adverse effects

Heparin - pharmacokinetics

Heparin - therapeutic use

Humans

Male

Thrombocytopenia - blood

Thrombocytopenia - chemically induced

Details

Title: Subtitle: Heparin Reexposure in Patients With a History of Heparin-Induced Thrombocytopenia
Creators: Prajwal Dhakal - Tribhuvan University
Smith Giri - University of Tennessee Health Science Center
Ranjan Pathak - Reading Hospital
Vijaya Raj Bhatt - University of Nebraska Medical Center
Resource Type: Journal article
Publication Details: Clinical and applied thrombosis/hemostasis, Vol.21(7), pp.626-631
DOI: 10.1177/1076029615578167
PMID: 25804614
ISSN: 1076-0296
eISSN: 1938-2723
Language: English
Date published: 10/2015
Academic Unit: Hematology, Oncology, and Blood & Marrow Transplantation; Internal Medicine
Record Identifier: 9984359678502771

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