Heparin-induced thrombocytopenia in intensive care patients.

摘要: OBJECTIVE: To summarize new information on frequency of heparin-induced thrombocytopenia (HIT) in patients treated intensive care units (ICU), developments the interpretation assays for detecting anti-PF4/heparin antibodies, and treatment HIT patients. STUDY SELECTION: All data laboratory-confirmed ICU were included; laboratory testing patients, this review focuses recent that became available 2005 2006. DATA EXTRACTION AND SYNTHESIS: is a potentially life-threatening adverse effect heparin caused by platelet-activating antibodies immunoglobulin G class usually recognizing complexes platelet factor 4 heparin. more often unfractionated than low-molecular-weight common postsurgical medical patients. In setting, uncommon (0.3-0.5%), whereas from other causes very (30-50%). For diagnosis both antigen functional (platelet activation) are available. Both tests sensitive (high negative predictive value) but specificity problematic, especially assays, which also detect nonpathogenic M A antibodies. Detection or could lead to events such as bleeding if false prompts replacement an alternative anticoagulant. HIT, three anticoagulants approved: direct thrombin inhibitors, lepirudin argatroban, heparinoid, danaparoid (not approved United States). Recent indicate dosing regimens inhibitors too high, patients. CONCLUSIONS: affects <1% even though 30-50% develop thrombocytopenia. The choice optimal anticoagulant depends patient characteristics. Many require lower doses those recommended manufacturer.