Thrombopénie induite à l'héparine et syndrome coronarien aigu

Service de réanimation et maladies infectieuses, centre hospitalier de Belfort-Montbéliard, 14, rue de Mulhouse, 90000 Belfort, France
Réanimation 04/2006; 15(2). DOI: 10.1016/j.reaurg.2005.12.025


Heparin-induced thrombocytopenia (HIT) is a relatively common immune-mediated disorder due to the development of IgG antibody specific to platelet factor 4. More frequent with the use of unfractionated heparine after the 5th day of treatment, this complication is defined as a decrease in platelet count of up to 40% and/or

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    ABSTRACT: Hypersensitivity to heparin and heparin-like compounds is a rare condition that represents therapeutic challenges for patients requiring a cardiopulmonary bypass (CPB). We here report the case of a woman with a combined allergy to heparins (fractionated and unfractionated), danaparoid and fondaparinux. She underwent a mitral valve replacement under CBP using lepirudin for systemic anticoagulation. The use of lepirudin instead of unfractionated heparin (UFH) in this setting has many important implications. Lepirudin therapeutic index is narrow and so, overdosing can lead to catastrophic bleeding, whereas underdosing can result in clotting in the CPB tubing. Monitoring of lepirudin activity is essential. The usual activated clotting time monitoring is not a reliable method to monitor anticoagulation with lepirudin in the operating theater. Our experience suggests that the diluted thrombin time provides a valuable alternative during CPB.
    Blood coagulation & fibrinolysis: an international journal in haemostasis and thrombosis 07/2014; 25(8). DOI:10.1097/MBC.0000000000000152 · 1.40 Impact Factor