PMID- 18984950
OWN - NLM
STAT- MEDLINE
DCOM- 20090305
LR  - 20201209
IS  - 1421-9786 (Electronic)
IS  - 1015-9770 (Linking)
VI  - 26
IP  - 6
DP  - 2008
TI  - Heparin-induced thrombocytopenia: a serious complication of heparin therapy for 
      acute stroke.
PG  - 641-9
LID - 10.1159/000166841 [doi]
AB  - BACKGROUND: Despite the lack of supporting evidence, unfractionated heparin (UFH) 
      is frequently given to acute ischemic stroke patients. This study was designed to 
      determine the incidence of heparin-induced thrombocytopenia (HIT) during acute 
      stroke and to elucidate the clinical features of stroke patients with HIT. 
      METHODS: Of 1,078 consecutive patients with acute ischemic stroke, 392 were given 
      intravenous UFH. Ten of these developed prominent thrombocytopenia without any 
      other underlying etiology; they were suspected of having HIT. These 10 patients 
      were studied retrospectively. The clinical diagnosis of HIT was made according to 
      two published scoring systems. Antiplatelet factor 4/heparin antibodies in the 
      plasma were detected by the enzyme-linked immunosorbent assay (ELISA) and were 
      confirmed by the 14C-serotonin release assay. RESULTS: Eight patients met the 
      criteria for clinical HIT according to both scoring systems. Of these, 
      serological tests were positive in 2 patients only on ELISA and in 2 patients on 
      both assays. The amount of UFH given was greater in the 4 patients with positive 
      serological findings than in the others (p = 0.043). Three patients developed 
      further thromboembolic events, including 1 patient who developed possible 
      cancer-associated thrombosis. Two patients were dead and the remaining 6 patients 
      were dependent at the time of hospital discharge. The clinical severity and 
      outcome of these patients were relatively unfavorable compared to other acute 
      patients. CONCLUSIONS: The prevalence of HIT was 0.5% based on both the clinical 
      scoring systems and serological assays. Monitoring for HIT should be included in 
      the medical management of stroke to avoid further complications.
CI  - 2008 S. Karger AG, Basel.
FAU - Kawano, Hiroyuki
AU  - Kawano H
AD  - Cerebrovascular Division, Department of Medicine, National Cardiovascular Center, 
      Suita, Japan.
FAU - Toyoda, Kazunori
AU  - Toyoda K
FAU - Miyata, Shigeki
AU  - Miyata S
FAU - Yamamoto, Haruko
AU  - Yamamoto H
FAU - Okamoto, Akira
AU  - Okamoto A
FAU - Kakutani, Isami
AU  - Kakutani I
FAU - Walenga, Jeanine M
AU  - Walenga JM
FAU - Naritomi, Hiroaki
AU  - Naritomi H
FAU - Minematsu, Kazuo
AU  - Minematsu K
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20081104
PL  - Switzerland
TA  - Cerebrovasc Dis
JT  - Cerebrovascular diseases (Basel, Switzerland)
JID - 9100851
RN  - 0 (Anticoagulants)
RN  - 0 (Autoantibodies)
RN  - 0 (Autoantigens)
RN  - 333DO1RDJY (Serotonin)
RN  - 37270-94-3 (Platelet Factor 4)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Acute Disease
MH  - Aged
MH  - Aged, 80 and over
MH  - Anticoagulants/*adverse effects
MH  - Autoantibodies/blood
MH  - Autoantigens/immunology
MH  - Blood Platelets/immunology/metabolism
MH  - Brain Damage, Chronic/etiology
MH  - Brain Ischemia/blood/*drug therapy
MH  - Enzyme-Linked Immunosorbent Assay
MH  - Female
MH  - Heparin/*adverse effects
MH  - Humans
MH  - Lung Neoplasms/complications
MH  - Male
MH  - Middle Aged
MH  - Platelet Factor 4/immunology
MH  - Purpura, Thrombocytopenic, Idiopathic/*chemically induced/diagnosis/immunology
MH  - Respiratory Distress Syndrome/complications
MH  - Risk Factors
MH  - Serotonin/metabolism
MH  - Severity of Illness Index
MH  - Thromboembolism/etiology
EDAT- 2008/11/06 09:00
MHDA- 2009/03/06 09:00
CRDT- 2008/11/06 09:00
PHST- 2007/12/27 00:00 [received]
PHST- 2008/07/04 00:00 [accepted]
PHST- 2008/11/06 09:00 [pubmed]
PHST- 2009/03/06 09:00 [medline]
PHST- 2008/11/06 09:00 [entrez]
AID - 000166841 [pii]
AID - 10.1159/000166841 [doi]
PST - ppublish
SO  - Cerebrovasc Dis. 2008;26(6):641-9. doi: 10.1159/000166841. Epub 2008 Nov 4.