Heparin-Induced Thrombocytopenia and Vascular Surgery |
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Authors: | L.E. Warkentin |
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Affiliation: | Department of Pathology and Molecular Medicine, and Department of Medicine, McMaster University, and the Hamilton Regional Laboratory Medicine Program, Hamilton, Ontario, Canada |
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Abstract: | Heparin-induced thrombocytopenia (HIT) is of special interest to vascular surgeons as heparin is the predominant anticoagulant used before, during, and after vascular surgery. Further, the prothrombotic nature of this antibody-mediated disorder leads to a high frequency of limb ischemia due to large arterial occlusion by platelet-rich (“white”) clots or because of extensive venous thrombosis involving large veins and small venules. This latter syndrome has been associated with coumarin anticoagulation of HIT-associated deep-vein thrombosis (coumarin-induced venous limb gangrene). Non-heparin anticoagulants, such as the direct thrombin inhibitors (lepirudin, argatroban), may be needed for intraoperative management of a patient with suspected acute HIT who requires vascular surgery. The transience of HIT antibodies provides a rationale for intraoperative use of heparin in a patient who has recovered from HIT and in whom HIT antibodies are no longer detectable. |
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Keywords: | Argatroban coumarin heparin lepirudin thrombocytopenia venous limb gangrene |
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