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Abstract
Background. Low molecular weight heparin (LMWH) and heparinoids have been offered as alternatives
to unfractionated heparin (UH) to patients with heparin-associated antiplatelet antibodies
(HAAb) and heparin-induced thrombocytopenia syndrome (HIT). Some of these patients
have had continued HIT in the presence of the UH substitutes. It would seem important
to know whether the heparin substitute is likely to cause patients' platelets to aggregate
before administering the substitute to patients with HAAb.
Methods. Patients with HIT were identified as having HAAb by positive platelet aggregometry
testing with commercial UH. Plasmas from 51 patients with HAAb were tested for the
ability to aggregate platelets in the presence of two LMWHs (Mono-Embolex NM and Fragmin)
and one heparinoid (Org 10172).
Results. The proportions of plasmas reacting to each UH substitute are Mono-Embolex NM, 60.8%;
Fragmin, 25.5%; and Org 10172, 19.6%. Although Fragmin and Org 10172 aggregated platelets
in the presence of HAAb significantly less often than Mono-Embolex NM (p < 0.001),
a patient with HAAb has a substantial chance of reacting to one of these UH substitutes.
Conclusions. Before giving a LMWH or heparinoid to a patient with HAAb, one should determine with
in vitro testing that the patient's HAAb will not cause platelet aggregation in the
presence of the heparin substitute.
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Article info
Footnotes
☆Presented at the Fiftieth Annual Meeting of the Central Surgical Association, Cincinnati, Ohio, March 4–6, 1993.
Identification
Copyright
© 1993 Published by Elsevier Inc.
