Heparin-Induced Thrombocytopenia and Vascular Surgery

Abstract

Heparin-induced thrombocytopenia (HIT) is of special interest to vascular surgeons as heparin is the predominant anticoagulant used before, during, and after vascular surgery. Further, the prothrombotic nature of this antibody-mediated disorder leads to a high frequency of limb ischemia due to large arterial occlusion by platelet-rich (“white”) clots or because of extensive venous thrombosis involving large veins and small venules. This latter syndrome has been associated with coumarin anticoagulation of HIT-associated deep-vein thrombosis (coumarin-induced venous limb gangrene). Non-heparin anticoagulants, such as the direct thrombin inhibitors (lepirudin, argatroban), may be needed for intraoperative management of a patient with suspected acute HIT who requires vascular surgery. The transience of HIT antibodies provides a rationale for intraoperative use of heparin in a patient who has recovered from HIT and in whom HIT antibodies are no longer detectable.

Key words:

• Argatroban
• coumarin
• heparin
• lepirudin
• thrombocytopenia
• venous limb gangrene

Additional information

Notes on contributors

L.E. Warkentin

Theodore E. Warkentin, MD Hamilton Regional Laboratory Medicine Program Hamilton Health sciences, General site 237 Barton st. E. Hamilton, Ontario L8L 2X2 Canada Tel: [phone] Fax: [phone] E-mail: [email protected]