PMID- 17655709
OWN - NLM
STAT- MEDLINE
DCOM- 20071130
LR  - 20151119
IS  - 0902-4441 (Print)
IS  - 0902-4441 (Linking)
VI  - 79
IP  - 3
DP  - 2007 Sep
TI  - Should patients be informed about the risk of heparin-induced thrombocytopenia 
      before prolonged low-molecular-weight heparin thromboprophylaxis 
      post-trauma/orthopedic surgery?
PG  - 187-90
AB  - OBJECTIVES: Heparin-induced thrombocytopenia (HIT) is an immune-mediated 
      prothrombotic adverse drug effect that occurs less frequently with 
      low-molecular-weight heparin (LMWH) than with unfractionated heparin (UFH) in 
      post-trauma/orthopedic surgery patients. The life-threatening nature of HIT 
      raises the question whether informed consent for this treatment-induced adverse 
      effect should be obtained, particularly as LMWH is often continued during the 
      outpatient period when clinical and platelet count monitoring become problematic. 
      Paradoxically, refusal of thromboprophylaxis as a result of seeking informed 
      consent could increase risk for thrombosis. METHODS: We evaluated in patients 
      undergoing routine LMWH thromboprophylaxis post-trauma/orthopedic surgery the 
      feasibility of obtaining informed consent, using a standardized questionnaire to 
      determine patient preferences. We also identified the proportion of HIT patients 
      in our laboratory comprised of trauma/orthopedic surgery patients from 1995-1997 
      and 2002-2004 (time periods characterized, respectively, by UFH and LMWH 
      thromboprophylaxis for this patient population). RESULTS: None of 460 patients in 
      whom informed consent was administered rejected LMWH thromboprophylaxis. The 
      patients' perception of the informed consent process and the written information 
      provided about the risk of HIT and its risk due to clinical consequences were 
      highly favorable. From 1995-1997 to 2002-2004, the proportion of HIT identified 
      among trauma/orthopedic surgery patients declined from 30.3% to 1.2% (P < 
      0.0001). CONCLUSIONS: Obtaining informed consent about HIT is feasible in written 
      form and does not cause refusal of LMWH thromboprophylaxis. Despite the uncommon 
      occurrence of HIT during LMWH thromboprophylaxis, informed consent increases 
      patient's awareness of this potentially life-threatening adverse drug effect, an 
      outcome that could increase outpatient recognition of the diagnosis.
FAU - Lubenow, Norbert
AU  - Lubenow N
AD  - Institut fur Immunologie und Transfusionsmedizin, Ernst-Moritz-Arndt-Universitat, 
      Greifswald, Germany. lubenow@uni-greifswald.de
FAU - Hinz, Peter
AU  - Hinz P
FAU - Ekkernkamp, Axel
AU  - Ekkernkamp A
FAU - Greinacher, Andreas
AU  - Greinacher A
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20070726
PL  - England
TA  - Eur J Haematol
JT  - European journal of haematology
JID - 8703985
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Adult
MH  - Aged
MH  - *Ethics, Medical
MH  - Female
MH  - Heparin/*adverse effects
MH  - Heparin, Low-Molecular-Weight/*therapeutic use
MH  - Humans
MH  - Informed Consent/*ethics
MH  - Male
MH  - Middle Aged
MH  - Orthopedic Procedures/methods
MH  - Postoperative Complications/*prevention & control
MH  - Premedication
MH  - Risk
MH  - Surveys and Questionnaires
MH  - Thrombocytopenia/*chemically induced
MH  - Wounds and Injuries/drug therapy
EDAT- 2007/07/28 09:00
MHDA- 2007/12/06 09:00
CRDT- 2007/07/28 09:00
PHST- 2007/07/28 09:00 [pubmed]
PHST- 2007/12/06 09:00 [medline]
PHST- 2007/07/28 09:00 [entrez]
AID - EJH891 [pii]
AID - 10.1111/j.1600-0609.2007.00891.x [doi]
PST - ppublish
SO  - Eur J Haematol. 2007 Sep;79(3):187-90. doi: 10.1111/j.1600-0609.2007.00891.x. 
      Epub 2007 Jul 26.