PMID- 12797878
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20191120
IS  - 1529-7535 (Print)
IS  - 1529-7535 (Linking)
VI  - 2
IP  - 2
DP  - 2001 Apr
TI  - Low-dose danaparoid sodium catheter flushes in an intensive care infant suffering 
      from heparin-induced thrombocytopenia.
PG  - 175-177
AB  - OBJECTIVE: Despite controversy about whether peripheral and central venous 
      catheters should be locked with heparin to prevent catheter-associated clotting, 
      the practice is widespread. We describe a severe side effect of the practice: a 
      case of heparin-induced thrombocytopenia occurring with catheter flushes using 
      unfractionated heparin (UFH) in a 10-month-old boy successfully treated with 
      danaparoid. Patient: A preterm-born patient (33 wks gestational age, birth weight 
      1200 g) suffering from VACTERL syndrome was repeatedly treated with UFH in the 
      context of several invasive procedures. On day 310 of age, a central venous 
      catheter was inserted to provide total parenteral nutrition. The central catheter 
      was flushed with a continuous infusion of UFH at 100 U/day, and a decrease in 
      platelet counts from 150,000/&mgr;L (on day 310 of age) to 45,000/&mgr;L (on day 
      319 of age) was observed. Clinically suspected heparin-induced thrombocytopenia 
      (HIT) was serologically confirmed by demonstrating HIT antibodies with platelet 
      factor 4/heparin complex specificity. Main Result: Catheter flushing was switched 
      to low-dose danaparoid sodium as a continuous infusion at 15 anti-factor Xa units 
      per day. Two days later, platelet counts recovered. Neither catheter thrombosis 
      nor systemic thromboembolic complications occurred during the follow up period. 
      CONCLUSIONS: Even continuous infusion of low-dose heparin to provide patency of 
      central venous port catheters may trigger the primary immune response of HIT. 
      Low-dose danaparoid sodium, a heparinoid, can prevent in-catheter thrombus 
      formation and allows normalization of platelet counts in acute HIT.
FAU - Ranze, Oliver
AU  - Ranze O
AD  - Institute of Immunology and Transfusion Medicine (Dr. Oliver Ranze, Dr. Petra 
      Ranze, Dr. Greinacher, and Ms. Eichler) and the Department of Pediatrics (Drs. 
      Rakow and Fusch), Division of Neonatology and Pediatric Intensive Care, 
      Ernst-Moritz-Arndt University, Greifswald, Germany. E-mail: 
      greinach@mail.uni-greifswald.de
FAU - Rakow, Alexander
AU  - Rakow A
FAU - Ranze, Petra
AU  - Ranze P
FAU - Eichler, Petra
AU  - Eichler P
FAU - Greinacher, Andreas
AU  - Greinacher A
FAU - Fusch, Christoph
AU  - Fusch C
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Pediatr Crit Care Med
JT  - Pediatric critical care medicine : a journal of the Society of Critical Care 
      Medicine and the World Federation of Pediatric Intensive and Critical Care 
      Societies
JID - 100954653
EDAT- 2003/06/12 05:00
MHDA- 2003/06/12 05:01
CRDT- 2003/06/12 05:00
PHST- 2003/06/12 05:00 [pubmed]
PHST- 2003/06/12 05:01 [medline]
PHST- 2003/06/12 05:00 [entrez]
AID - 10.1097/00130478-200104000-00013 [doi]
PST - ppublish
SO  - Pediatr Crit Care Med. 2001 Apr;2(2):175-177. doi: 
      10.1097/00130478-200104000-00013.