Heparin-induzierte Thrombozytopenie Typ II und ... - Vascularcare.de
Heparin-induzierte Thrombozytopenie Typ II und ... - Vascularcare.de Heparin-induzierte Thrombozytopenie Typ II und ... - Vascularcare.de
ZusammenfassungHerzchirurgische Patienten weisen eineim Vergleich zu anderen Patientengruppenhohe Inzidenz von HIT-II-Antikörpernund auch klinisch nachgewiesenen HIT-II-Erkrankungsfällen auf. Postoperativ erfordertbereits der dringende HIT-II-Verdachtdie Umstellung auf ein sicheres Antikoagulansund die Einleitung einer serologischenDiagnostik; sonografisch sind okkulte Bein–und Beckenvenenthrombosen abzuklären.Zur postoperativen Antikoagulation stehenunterschiedliche Substanzen zur Verfügung,von denen allerdings nicht alleeine Zulassung für die Behandlung vonPatienten mit HIT II besitzen.Für die Antikoagulation an der HLM beiPatienten mit bekannter HIT II ist nach denaktuellen Empfehlungen der Antikörperstatusentscheidend. Sind keine oder nurniedrige Antikörpertiter nachweisbar, kanneine einmalige Gabe von Heparin währendder Operation erfolgen. Befindet sich derPatient noch in einem akuten Stadium derHIT II mit positivem Antikörper- und Funktionstest(z.B. Plättchenaggregationstest,HIPA), ist eine alternative Antikoagulationmit Lepirudin, Danaparoid oder Bivalirudinzugelassen und klinisch indiziert.Alternativ kommt eine thrombozytenaggregationshemmendeTherapie mit Prostazyklinoder einem GP-IIb/IIIa-Inhibitor inFrage, nach dessen Aufsättigung die einmaligeGabe von Heparin erfolgen kann.Postoperativ muss in beiden Fällen eineHIT-II-sichere Antikoagulation erfolgen.Literatur[1] Addonizio VP Jr, Fisher CA, Kappa JR, Ellison N: Prevention ofheparin-induced thrombocytopenia during open heart surgery withiloprost (ZK36374). Surgery 102 (1987) 796–807[2] Amiral J, Bridey F, Wolf M, Boyer-Neumann C, Fressinaud E, VissacAM, Peynaud-Debayle E, Dreyfus M, Meyer D: Antibodies tomacromolecular platelet factor 4-heparin complexes in HIT: a studyof 44 cases. Thrombosis and Haemostasis 3 (1995) 21–28[3] Antoniou T, Kapetanakis EI, Theodoraki K, Rellia P, Thanopoulos A,Kotiou M, Zarkalis D, Alivizatos P: Cardiac surgery in patients withheparin-induced thrombocytopenia using preoperatively determineddosages of iloprost. Heart Surg Forum 5 (2002) 354–57[4] Aouifi A, Blanc P, Piriou V, Bastien OH, French P, Hanss M, Lehot JJ:Cardiac surgery with cardiopulmonary bypass in patients with typeII heparin-induced thrombocytopenia. Ann Thorac Surg. 71 (2001)678–83[5] Bauer TL, Arepally G, Konkle BA, Mestichelli B, Shapiro SS, CinesDB, Poncz M, McNulty S, Amiral J, Hauck WW, Edie RN, MannionJD: Preva-lence of heparin-associated antibodies without thrombosisin patients undergoing cardiopulmonary bypass surgery.Circulation. 95 (1997) 1242–46[6] Cines DB, Tomaski A, Tannenbaum S. Immune endothelial-cell injuryin heparin-associated thrombocytopenia. N Engl J Med 316 (1987)581–89[7] Claeys LG: Lethal heparin-associated pulmonary embolism – casereports. Angiology 53 (2002) 475–78[8] Greinacher A, Alban S, Omer-Adam MA, Weitschies W, WarkentinTE: Heparin-induced thrombocytopenia: A stoichiometry-basedmodel to explain the differing immunogenicities of unfractionatedheparin, low-molecular-weight heparin, and fondaparinux indifferent clinical settings. Thromb Res Feb 7 (2008) [Epub ahead ofprint])[9] Greinacher A, Farner B, Kroll H, Kohlmann T, Warkentin TE, EichlerP: Clinical features of heparin-induced thrombocytopenia includingrisk factors of thrombosis. A retrospective analysis of 408 patients.Thromb Haemost 94 (2005) 132–35[10] Greinacher A, Michels I, Kiefel V, Mueller-Eckhardt C: A rapid andsensitive test for diagnosing heparin-associated thrombocytopenia.Thrombosis and Haemostasis 66 (1991) 734–36[11] Greinacher A, Michels I, Mueller-Eckhardt C: Heparin-associatedthrombocytopenia: the antibody is not heparin specific. ThrombHaemost 67 (1992) 545–49[12] Greinacher A: Heparin-induced thrombocytopenia: Frequency andpathogenesis. Pathophysiol Haemost Thromb 35 (2006) 37–45Vascular Care 1/2009 Vol. 16 55
Originalie[13] Kelton JG, Smith JW, Warkentin TE, Hayward CP, Denomme GA,Horsewood P: Immunoglobulin G from patients with heparininducedthrombocytopenia binds to a complex of heparin andplatelet factor 4. Blood 83 (1994) 3232–39[14] Koster A, Crystal GJ, Kuppe H, Mertzlufft F: Acute heparin-inducedthrombocytopenia type II during cardiopulmonary bypass. J CardiothoracVasc Anesth. 14 (2000) 300–303[15] Koster A, Kukucka M, Bach F, Meyer O, Fischer T, Mertzlufft F, LoebeM, Hetzer R, Kuppe H: Anticoagulation during cardiopulmonarybypass in patients with heparin-induced thrombocytopenia type IIand renal impairment using heparin and the platelet glycoproteinIIb-IIIa antagonist tirofiban. Anesthesiology. 94 (2001) 245–51[16] Kozek-Langenecker S: Direkte Thrombininhibitoren. AnästhesistMarch 2 (2008) [epub ahead of print][17] Lubenow N, Kempf R: Heparin-induced thrombocytopenia: temporalpat-tern of thrombocytopenia in relation to initial use or reexposure.Chest 122 (2002) 37–42[18] Martel N, Lee J, Wells PS: Risk for heparin-induced thrombocytopeniawith unfractionated heparin and low-molecular-weight heparinthromboprophylaxis: a meta-analysis. Blood 106 (2005) 2710–15[19] Merz S, Fehr R, Gulke C: Sinus vein thrombosis. A rare complicationof heparin-induced thrombocytopenia type II. Anaesthesist.53 (2004) 551–54[20] Meyer O, Salama A, Pittet N, Schwind P: Rapid detection ofheparin-induced antibodies with particle gel immunoassay(ID-HPF4). Lancet 354 (1999) 1525–26[21] Newman PM, Chong B: Heparin-induced thrombocytopenia: newevidence for the dynamic binding of purified anti-PF4-heparinantibodies to platelets and the resultant platelet activation. Blood96 (2000) 182–87[22] Olinger GN, Hussey CV, Olive JA, Malik MI. Cardiopulmonary bypassfor patients with previously documented heparin-induced plateletaggregation. J Thorac Cardiovasc Surg 87 (1984) 673-77[23] Pötzsch B, Klövekorn WP, Madlener K: Use of heparin during cardiopulmonarybypass in patients with a history of heparin-inducedthrombocytopenia. N Engl J Med. 343 (2000) 515[24] Pouplard C, Iochmann S, Renard B, Herault O, Colombat P, AmiralJ, Gruel Y: Induction of monocyte tissue factor expression byantibodies to heparin-platelet factor 4 complexes developed inheparin-induced thrombocytopenia. Blood 97 (2001) 3300–302[25] Pouplard C, May MA, Regina S, Marchand M, Fusciardi J, Gruel Y:Changes in platelet count after cardiac surgery can effectively predictthe development of pathogenic heparin-dependent antibodies.Br J Haematol 128 (2005) 837–41[26] Selleng S, Lubenow N, Wollert HG, Müllejans B, Greinacher A:Emergency cardiopulmonary bypass in a bilaterally nephrectomizedpatient with a history of heparin-induced thrombocytopenia:successful reexposure to heparin. Ann Thorac Surg 71 (2001)1041–42[27] Selleng S, Selleng K, Wollert HG, Müllejans B, Lietz T, Warkentin TE,Greinacher A: Heparin-induced thrombocytopenia in patients requiringprolonged intensive care unit treatment after cardiopulmonarybypass. J Thromb Haemost 6 (2008) 428–35[28] Sheridan D, Carter C, Kelton JG: A diagnostic test for heparininducedthrombocytopenia. Blood 67 (1986) 27–30[29] von Heymann C, Hagemeyer E, Kastrup M, Ziemer S, Proquitté H,Konertz WF, Spies C: Heparin-induced thrombocytopenia type II inan infant with a congenital heart defect-anticoagulation duringcardiopulmonary bypass with epoprostenol sodium and heparin.Pediatr Crit Care Med 7 (2006) 383–85[30] von Heymann C, Vargas Hein O, Kastrup M, Morgera S, Ziemer S,Spies C: Heparin-induzierte Thrombozytopenie Typ II (HIT II) in deroperativen Medizin – Therapeutische Optionen. Vascular Care 8(2005) 34–53[31] Walenga JM, Jeske WP, Prechel MM, Bakhos M: Newer insightson the mechanism of heparin-induced thrombocytopenia. SeminThromb Hemost. 30 (2004) 57–67[32] Wallis DE, Workman DL, Lewis BE: Failure of early heparin cessationas treatment for heparin-induced thrombocytopenia. Am J Med 106(1999) 629–35[33] Warkentin TE, Chong BH, Greinacher A: Heparin-induced thrombocytope-nia:Towards consensus. Thromb Haemost 79 (1998) 1–7[34] Warkentin TE, Cook RJ, Marder VJ, Sheppard JA, Moore JC,Eriksson BI, Greinacher A, Kelton JG: Anti-platelet factor 4/heparinantibodies in orthopedic surgery patients receiving antithromboticprophylaxis with fondaparinux or enoxaparin. Blood 106 (2005)3791–96[35] Warkentin TE, Elavathil LJ, Hayward CP, Johnston MA, Russett JI,Kelton JG: The pathogenesis of venous limb gangrene associatedwith heparin-induced thrombocytopenia. Ann Intern Med 127(1997) 804–12[36] Warkentin TE, Greinacher A. Heparin-induced thrombocytopenia:recognition, treatment, and prevention: the Seventh ACCP Conferenceon Antithrombotic and Thrombolytic Therapy. Chest. 126(3Suppl) (2004) 311S–337S[37] Warkentin TE, Greinacher A: Heparin-induced Thrombocytopeniaand Cardiac Surgery. Ann Thorac Surg 76 (2003) 2121–31[38] Warkentin TE, Kelton JG: Delayed-onset heparin-induced thrombocytopeniaand thrombosis. Ann Intern Med. 135 (2001) 502–656 Vascular Care 1/2009 Vol. 16
- Seite 3 und 4: OriginalieCHRISTIAN VON HEYMANN, HE
- Seite 5 und 6: OriginalieCHRISTIAN VON HEYMANN, HE
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Originalie[13] Kelton JG, Smith JW, Warkentin TE, Hayward CP, Denomme GA,Horsewood P: Immunoglobulin G from patients with heparininducedthrombocytopenia binds to a complex of heparin andplatelet factor 4. Blood 83 (1994) 3232–39[14] Koster A, Crystal GJ, Kuppe H, Mertzlufft F: Acute heparin-inducedthrombocytopenia type <strong>II</strong> during cardiopulmonary bypass. J CardiothoracVasc Anesth. 14 (2000) 300–303[15] Koster A, Kukucka M, Bach F, Meyer O, Fischer T, Mertzlufft F, LoebeM, Hetzer R, Kuppe H: Anticoagulation during cardiopulmonarybypass in patients with heparin-induced thrombocytopenia type <strong>II</strong>and renal impairment using heparin and the platelet glycoprotein<strong>II</strong>b-<strong>II</strong>Ia antagonist tirofiban. Anesthesiology. 94 (2001) 245–51[16] Kozek-Langenecker S: Direkte Thrombininhibitoren. AnästhesistMarch 2 (2008) [epub ahead of print][17] Lubenow N, Kempf R: <strong>Heparin</strong>-induced thrombocytopenia: temporalpat-tern of thrombocytopenia in relation to initial use or reexposure.Chest 122 (2002) 37–42[18] Martel N, Lee J, Wells PS: Risk for heparin-induced thrombocytopeniawith unfractionated heparin and low-molecular-weight heparinthromboprophylaxis: a meta-analysis. Blood 106 (2005) 2710–15[19] Merz S, Fehr R, Gulke C: Sinus vein thrombosis. A rare complicationof heparin-induced thrombocytopenia type <strong>II</strong>. Anaesthesist.53 (2004) 551–54[20] Meyer O, Salama A, Pittet N, Schwind P: Rapid <strong>de</strong>tection ofheparin-induced antibodies with particle gel immunoassay(ID-HPF4). Lancet 354 (1999) 1525–26[21] Newman PM, Chong B: <strong>Heparin</strong>-induced thrombocytopenia: newevi<strong>de</strong>nce for the dynamic binding of purified anti-PF4-heparinantibodies to platelets and the resultant platelet activation. Blood96 (2000) 182–87[22] Olinger GN, Hussey CV, Olive JA, Malik MI. Cardiopulmonary bypassfor patients with previously documented heparin-induced plateletaggregation. J Thorac Cardiovasc Surg 87 (1984) 673-77[23] Pötzsch B, Klövekorn WP, Madlener K: Use of heparin during cardiopulmonarybypass in patients with a history of heparin-inducedthrombocytopenia. N Engl J Med. 343 (2000) 515[24] Pouplard C, Iochmann S, Renard B, Herault O, Colombat P, AmiralJ, Gruel Y: Induction of monocyte tissue factor expression byantibodies to heparin-platelet factor 4 complexes <strong>de</strong>veloped inheparin-induced thrombocytopenia. Blood 97 (2001) 3300–302[25] Pouplard C, May MA, Regina S, Marchand M, Fusciardi J, Gruel Y:Changes in platelet count after cardiac surgery can effectively predictthe <strong>de</strong>velopment of pathogenic heparin-<strong>de</strong>pen<strong>de</strong>nt antibodies.Br J Haematol 128 (2005) 837–41[26] Selleng S, Lubenow N, Wollert HG, Müllejans B, Greinacher A:Emergency cardiopulmonary bypass in a bilaterally nephrectomizedpatient with a history of heparin-induced thrombocytopenia:successful reexposure to heparin. Ann Thorac Surg 71 (2001)1041–42[27] Selleng S, Selleng K, Wollert HG, Müllejans B, Lietz T, Warkentin TE,Greinacher A: <strong>Heparin</strong>-induced thrombocytopenia in patients requiringprolonged intensive care unit treatment after cardiopulmonarybypass. J Thromb Haemost 6 (2008) 428–35[28] Sheridan D, Carter C, Kelton JG: A diagnostic test for heparininducedthrombocytopenia. Blood 67 (1986) 27–30[29] von Heymann C, Hagemeyer E, Kastrup M, Ziemer S, Proquitté H,Konertz WF, Spies C: <strong>Heparin</strong>-induced thrombocytopenia type <strong>II</strong> inan infant with a congenital heart <strong>de</strong>fect-anticoagulation duringcardiopulmonary bypass with epoprostenol sodium and heparin.Pediatr Crit Care Med 7 (2006) 383–85[30] von Heymann C, Vargas Hein O, Kastrup M, Morgera S, Ziemer S,Spies C: <strong>Heparin</strong>-<strong>induzierte</strong> <strong>Thrombozytopenie</strong> <strong>Typ</strong> <strong>II</strong> (HIT <strong>II</strong>) in <strong>de</strong>roperativen Medizin – Therapeutische Optionen. Vascular Care 8(2005) 34–53[31] Walenga JM, Jeske WP, Prechel MM, Bakhos M: Newer insightson the mechanism of heparin-induced thrombocytopenia. SeminThromb Hemost. 30 (2004) 57–67[32] Wallis DE, Workman DL, Lewis BE: Failure of early heparin cessationas treatment for heparin-induced thrombocytopenia. Am J Med 106(1999) 629–35[33] Warkentin TE, Chong BH, Greinacher A: <strong>Heparin</strong>-induced thrombocytope-nia:Towards consensus. Thromb Haemost 79 (1998) 1–7[34] Warkentin TE, Cook RJ, Mar<strong>de</strong>r VJ, Sheppard JA, Moore JC,Eriksson BI, Greinacher A, Kelton JG: Anti-platelet factor 4/heparinantibodies in orthopedic surgery patients receiving antithromboticprophylaxis with fondaparinux or enoxaparin. Blood 106 (2005)3791–96[35] Warkentin TE, Elavathil LJ, Hayward CP, Johnston MA, Russett JI,Kelton JG: The pathogenesis of venous limb gangrene associatedwith heparin-induced thrombocytopenia. Ann Intern Med 127(1997) 804–12[36] Warkentin TE, Greinacher A. <strong>Heparin</strong>-induced thrombocytopenia:recognition, treatment, and prevention: the Seventh ACCP Conferenceon Antithrombotic and Thrombolytic Therapy. Chest. 126(3Suppl) (2004) 311S–337S[37] Warkentin TE, Greinacher A: <strong>Heparin</strong>-induced Thrombocytopeniaand Cardiac Surgery. Ann Thorac Surg 76 (2003) 2121–31[38] Warkentin TE, Kelton JG: Delayed-onset heparin-induced thrombocytopeniaand thrombosis. Ann Intern Med. 135 (2001) 502–656 Vascular Care 1/2009 Vol. 16
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