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Review

Heparin-induced thrombocytopenia

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Pages 547-559 | Published online: 10 Jan 2014

References

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  • ••First report of two clinical types ofheparin-induced thrombocytopenia (HIT): Type I, no detectable HIT antibody and patients are asymptomatic; Type II, HIT antibody detectable and patients frequently have associated thrombotic complications.
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  • ••First report to show that the antibody inHIT is directed against the platelet factor (PF) 4-heparin complex.
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  • ••Incidence of HIT is low in patientsreceiving low-molecular-weight heparin
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  • Warkentin TE, Sheppard JA, Horsewood P, Simpson PJ, Moore JC, Kelton JG. Impact of the patient population on the risk for heparin-induced thrombocytopenia. Blood 96, 1703–1708 (2000).
  • ••Clearly demonstrates that the patient population has an impact on the risk of HIT. The authors found that patients who had undergone hip surgery were more likely to develop HIT than those who had cardiac surgery.
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  • Newman E Chong BH. Heparin-induced thrombocytopenia: the major antigenic epitope is on the modified platelet Factor 4 and not on heparin. Br J HaematoL 107, 303–309 (1999).
  • ••Shows convincingly that the epitope of theHIT antibody is on PF4 and not on heparin of the PF4—heparin complex.
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  • •Shows a high frequency of anti-PF4/heparin antibodies in patients after cardiopulmonary bypass (CPB).
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  • •A further demonstration of the high frequency of anti-PF4/heparinantibodies in patients after CPB.
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  • ••Demonstrates that platelet activation by theHIT antibody is mediated via platelet FcyRII.
  • Newman P, Chong BH. Heparin-induced thrombocytopenia: new evidence for the dynamic binding of purtied anti-PF4—heparin antibodies to platelets and the resulting activation. Blood 96, 182–187 (2000).
  • ••HIT antibody binds to PF4—heparincomplexes on the platelet surface via its Fab domain after the antibody has induced PF4 release from the platelets.
  • Kelton JG, Sheridan D, Santos A et al Heparin-induced thrombocytopenia: laboratory studies. B/ood72, 925–930 (1998).
  • ••Platelet activation by the HIT antibody ismediated via platelet FcyRII.
  • Warkentin TE, Hayward CPM, Boshkov LK et al Sera from patients with heparin-induced thrombocytopenia generated platelet-derived micropartides with procoagulant activity: an explanation for the thrombotic complications of heparin-induced thrombocytopenia. Blood 84, 3691–3699 (1994).
  • ••The HIT antibody can generate platelet-derived microparticles that have procoagulant activity.
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  • ••First paper to show that the HIT antibodycan generate thromboxane A2, a potent platelet aggregating molecule, and can also produce platelet procoagulant activity without causing platelet lysis.
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  • •Shows interaction of anti-PF4/heparin antibodies with monocytes leading to tissue factor expression.
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  • •Demonstrates interaction of anti-PF4/heparin antibodies with monocytes leading to tissue factor expression.
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  • ••HIT antibody can bind to endothelial cellsand cause immunoinjury.
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  • •Demonstrates that interleukin-8 or neutrophil-activating peptide-2 may also be the autoantigen in some patients with HIT.
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  • •Shows a high frequency of anti-PF4/heparin antibodies in patients who undergo CPB.
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  • Warkentin TE, Hong AP Frequency of upper limb deep-venous thrombosis (UL-DVT) in relation to central venous catheter (CVC) use in patients with heparin-induced thrombocytopenia (HIT): evidence for interaction of systemic (HIT) and local (CVC) prothrombotic risk factors. Blood 92\(Suppl. 1), 500a-510a (1998) (Abstract).
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  • ••One of the earlier papers that clearly demonstrates the association of disastrous thrombotic complications with HIT.
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  • ••Clearly identifies the optimal experimentalconditions for the platelet aggregation test, showing that the test result can be affected by donor platelet variability, the heparin concentration and the immunoglobulin (Ig)G in plasma.
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  • ••First description of the two-point 14Cserotonin release test, defining the experimental conditions for a specific and sensitive test for HIT.
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  • ••First description of the heparin-inducedplatelet aggregation assay.
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  • •First description of a flow cytometry test for HIT.
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  • •Describes a sensitive fluid-phase assay for measuring anti-PF4/heparin antibodies.
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  • ••Reports another important prospectivehistorical controlled trial of lepirudin in HIT patients.
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  • ••Reports the first prospective historicalcontrolled trial of lepirudin in HIT patients.
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  • ••Reports the first prospective, randomized,controlled trial in the management of thrombosis in HIT patients comparing danaparoid and dextran 70.
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  • ••Reports the association of limb gangrenewith warfarin therapy in HIT patients.
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  • •Reports that anaphylactic reactions, although rare, can occur in HIT patients treated with lepirudin.
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  • ••Describes a large clinical experience ofdanaparoid treatment in HIT patients.
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  • ••First report of a prospective, historical,controlled trial of argatroban in the treatment of HIT.
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  • ••Report of another prospective, historical,controlled trial of argatroban in the treatment of HIT.
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  • •Reports on a prospective study of argatroban in patients undergoing percutaneous coronary intervention.
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