PMID- 25804614
OWN - NLM
STAT- MEDLINE
DCOM- 20160606
LR  - 20150904
IS  - 1938-2723 (Electronic)
IS  - 1076-0296 (Linking)
VI  - 21
IP  - 7
DP  - 2015 Oct
TI  - Heparin Reexposure in Patients With a History of Heparin-Induced 
      Thrombocytopenia.
PG  - 626-31
LID - 10.1177/1076029615578167 [doi]
AB  - OBJECTIVES: Patients with a history of heparin-induced thrombocytopenia (HIT), 
      who require subsequent anticoagulation, have limited options. Rechallenge with 
      unfractionated heparin (UFH) has been reported but may be associated with a risk 
      of recurrence of HIT. The objective of this study was to determine the safety of 
      heparin reexposure in patients with a history of HIT. METHODS: Using several 
      search terms, all cases of heparin reexposure in patients with HIT indexed in 
      MEDLINE (English language only) by June 2014 were reviewed. The bibliography of 
      each relevant article was searched for additional reports. In cases of multiple 
      reexposures, each reexposure was identified as a separate instance of reexposure 
      during analysis. RESULTS: A total of 136 patients with a history of HIT had 141 
      instances of heparin reexposure. Cardiac (76%) and vascular surgeries (11%) were 
      the most common indications. Antiplatelet factor 4/heparin antibodies were 
      positive in 63% of evaluable cases before reexposure. Preexposure plasma exchange 
      (11%) and postexposure nonheparin anticoagulants (63%) were frequently utilized. 
      Complications with heparin reexposure included recurrence of HIT (2.1%, 95% 
      confidence interval 0.73%-6.07%) and bleeding (2.1%). CONCLUSION: Intraoperative 
      heparin reexposure in patients with a history of HIT has a small risk of 
      developing HIT recurrence. The use of preexposure plasma exchange in patients 
      with positive antiplatelet factor 4/heparin antibody and postexposure nonheparin 
      anticoagulants arguably may have reduced the risk of recurrence of HIT.
CI  - (c) The Author(s) 2015.
FAU - Dhakal, Prajwal
AU  - Dhakal P
AD  - Department of Medicine, Institute of Medicine, Tribhuvan University, Kathmandu, 
      Nepal.
FAU - Giri, Smith
AU  - Giri S
AD  - Department of Medicine, University of Tennessee Health Science Center, Memphis, 
      TN, USA.
FAU - Pathak, Ranjan
AU  - Pathak R
AD  - Department of Medicine, Reading Health System, Reading, PA, USA.
FAU - Bhatt, Vijaya Raj
AU  - Bhatt VR
AD  - Department of Internal Medicine, Division of Hematology-Oncology, University of 
      Nebraska Medical Center, Omaha, NE, USA vijaya.bhatt@unmc.edu.
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20150323
PL  - United States
TA  - Clin Appl Thromb Hemost
JT  - Clinical and applied thrombosis/hemostasis : official journal of the 
      International Academy of Clinical and Applied Thrombosis/Hemostasis
JID - 9508125
RN  - 0 (Anticoagulants)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - *Anticoagulants/adverse effects/pharmacokinetics/therapeutic use
MH  - *Cardiopulmonary Bypass
MH  - *Drug Monitoring
MH  - Female
MH  - *Heparin/adverse effects/pharmacokinetics/therapeutic use
MH  - Humans
MH  - Male
MH  - Thrombocytopenia/*blood/*chemically induced
OTO - NOTNLM
OT  - heparin-induced thrombocytopenia
OT  - low-molecular-weight heparin
OT  - nonheparin anticoagulant
OT  - plasma exchange
OT  - reexposure
OT  - unfractionated heparin
EDAT- 2015/03/26 06:00
MHDA- 2016/06/09 06:00
CRDT- 2015/03/26 06:00
PHST- 2015/03/26 06:00 [entrez]
PHST- 2015/03/26 06:00 [pubmed]
PHST- 2016/06/09 06:00 [medline]
AID - 1076029615578167 [pii]
AID - 10.1177/1076029615578167 [doi]
PST - ppublish
SO  - Clin Appl Thromb Hemost. 2015 Oct;21(7):626-31. doi: 10.1177/1076029615578167. 
      Epub 2015 Mar 23.