Plasmapheresis in the management of heparin-associated thrombocytopenia with thrombosis

✍ Scribed by Sucha Nand; John A. Robinson

• Publisher: John Wiley and Sons
• Year: 1988
• Tongue: English
• Weight: 228 KB
• Volume: 28
• Category: Article
• ISSN: 0361-8609
• DOI: 10.1002/ajh.2830280318

✦ Synopsis

Heparin-associated thrombocytopenia with thrombosis (HAW is fatal in 29% and leads to limb amputation in another 21% of patients. Patients with arterial thrombosis do worse than do those with venous thrombosis alone. Heparin-associated thrombocytopenia is mediated through IgG or IgM immunoglobulin fractions and is believed to be an immune phenomenon, with heparin acting as a hapten. In addition, endothelial injury may be responsible for the development of thrombosis. Heparin-induced platelet aggregation persists for weeks to months after its withdrawal in these patients. Acute management of HAlT includes surgical thrombectomy, thrombolytic therapy, dextran, ancrod, lowmolecular-weight heparin, and antiplatelet agents, but overall results remain unsatisfactory. We report the use of plasmapheresis, along with aspirin and dextran, in a patient with HAlT. The patient experienced pain relief in 1 day; the heparin-associated platelet aggregation test became negative in 5 days, and there was functional salvage of the affected limb. We suggest that plasmapheresis may be an effective therapy in the management of HATT.