Heparin-induced thrombocytopenia and thrombosis syndrome: In vivo cross-reactivity with danaparoid and successful treatment with r-Hirudin

• Published in: British journal of haematology Vol. 114; no. 2; pp. 394 - 396
• Main Authors: TEE BENG KENG, CHONG, Beng H
• Format: Journal Article
• Language: English
• Published: Oxford Blackwell 01.08.2001; Blackwell Publishing Ltd
• Subjects: Aged; Antibodies - metabolism; Anticoagulants - adverse effects; Atherosclerosis (general aspects, experimental research); Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Chondroitin Sulfates - adverse effects; Cross Reactions; Dermatan Sulfate - adverse effects; Drug Combinations; Factor Xa - immunology; Hematologic and hematopoietic diseases; Hematology; Heparin - adverse effects; Heparitin Sulfate - adverse effects; Hirudin Therapy; Humans; International Normalized Ratio; Male; Medical sciences; Platelet Count; Platelet diseases and coagulopathies; Syndrome; Thrombocytopenia - blood; Thrombocytopenia - chemically induced; Thrombocytopenia - immunology; Thrombosis - blood; Thrombosis - chemically induced; Thrombosis - immunology; Human; Thrombocytopenia; Immunopathology; Toxicity; Cardiovascular disease; Autoimmune disease; Low molecular weight heparin; Anticoagulant; Thrombosis; Hirudin; Vascular disease; In vivo; Treatment; Cross reaction; Glycosaminoglycan; Heparin; Recombinant protein; Danaparoid sodium
• ISSN: 0007-1048; 1365-2141
• DOI: 10.1046/j.1365-2141.2001.02943.x

Heparin-induced thrombocytopenia and thrombosis syndrome (HITTS) is an immune-mediated drug reaction that occurs 5-14 d after initiation of heparin therapy and is a potentially life-threatening thrombotic complication. The antibody-heparin-PF4 complexes cause platelet activation and generation of platelet microparticles. The need for anticoagulant treatment in asymptomatic thrombocytopenia is uncertain. However, treatment is warranted in HITTS, as illustrated in the case reported here. Danaparoid, r-Hirudin and argatroban are effective drugs. Danaparoid has a 10-50% in vitro cross-reactivity rate with the HIT antibodies, but has been proven to be clinically efficacious even in these cases. Here, we report a case of in vivo cross-reactivity with danaparoid, the patient showed an excellent recovery with r-Hirudin.