Document Detail


Danaparoid for heparin-induced thrombocytopenia: an analysis of treatment failures.
MedLine Citation:
PMID:  12890149     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Patients with heparin-induced thrombocytopenia (HIT) (with or without thrombosis) require alternative anticoagulation because of their extreme risk of new thromboembolic complications. The first effective agent for this purpose may be danaparoid, a less-sulfated low molecular weight heparinoid. Recently, direct thrombin inhibitors have been used. OBJECTIVE: Five HIT patients, who developed new thromboembolic complications while receiving danaparoid, were analyzed to consider possible reasons for treatment failure and to promulgate strategies that improve efficacy. RESULTS: Three patients had acute HIT, one had recent HIT, and one with remote HIT was re-exposed to heparin during heart surgery. Danaparoid was started as intravenous bolus and infusion in one patient, and as 1250 units subcutaneously twice daily in four patients. The new complications that emerged on danaparoid were new venous thrombi in three patients (one with pulmonary emboli), lower extremity arterial thrombosis in one, myocardial ischemia in one, thromboembolic cardiovascular accidents in one, and fatal bowel necrosis in one (two patients suffered more than one complication). Platelet counts did not improve or worsened in four, improved partially in the other, and parameters of disseminated intravascular coagulation failed to improve in one patient. Four patients responded relatively dramatically when direct thrombin inhibitors were substituted. Possible reasons for danaparoid failure include that: 1) no treatment is expected to completely prevent complications, 2) antithrombin III consumption can blunt efficacy in some patients, 3) low or intermediate doses may be insufficient, and 4) there was clinically significant cross-reactivity of the pathogenic HIT antibodies. CONCLUSIONS: It is emphasized that the possibility of clinically significant antibody cross-reactivity and that low or intermediate dosage may be inadequate when using danaparoid in therapy of HIT. The latter problem probably extrapolates to other anticoagulants used for HIT.
Authors:
Sandeep Kodityal; Amit H Manhas; Mark Udden; Lawrence Rice
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Publication Detail:
Type:  Case Reports; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  European journal of haematology     Volume:  71     ISSN:  0902-4441     ISO Abbreviation:  Eur. J. Haematol.     Publication Date:  2003 Aug 
Date Detail:
Created Date:  2003-07-31     Completed Date:  2003-09-17     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  8703985     Medline TA:  Eur J Haematol     Country:  Denmark    
Other Details:
Languages:  eng     Pagination:  109-13     Citation Subset:  IM    
Affiliation:
The Department of Medicine, Section of Hematology, Baylor College of Medicine, Houston, TX, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Anticoagulants / adverse effects*,  therapeutic use
Antithrombins / therapeutic use
Chondroitin Sulfates / administration & dosage,  adverse effects*
Cross Reactions
Dermatan Sulfate / administration & dosage,  adverse effects*
Disseminated Intravascular Coagulation
Drug Combinations
Female
Heparin / adverse effects*,  immunology
Heparitin Sulfate / administration & dosage,  adverse effects*
Humans
Male
Middle Aged
Platelet Count
Thrombocytopenia / chemically induced,  drug therapy*,  immunology
Thrombosis / chemically induced
Treatment Failure
Chemical
Reg. No./Substance:
0/Anticoagulants; 0/Antithrombins; 0/Drug Combinations; 24967-94-0/Dermatan Sulfate; 83513-48-8/danaproid; 9005-49-6/Heparin; 9007-28-7/Chondroitin Sulfates; 9050-30-0/Heparitin Sulfate

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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