Enoxaparin sodium/heparin
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Heparin-induced thrombocytopenia: 2 case reports Two patients developed heparin-induced thrombocytopenia (HIT) during treatment with enoxaparin sodium and heparin [routes not stated]. A 68-year-old man began receiving thromboprophylaxis with enoxaparin sodium 40mg daily after sustaining a pelvic fracture. His platelet count gradually decreased to 18 × 109/L over the following 6 days. The next day, he developed dyspnoea and tachycardia. Pulmonary embolism was seen on a CT scan, while an ultrasound of the legs revealed thrombosis in the left popliteal vein. A filter was placed in the inferior vena cava, and enoxaparin sodium was discontinued. Due to suspected HIT, thromboprophylaxis was restarted with danaparoid sodium, which was later switched to fondaparinux sodium. He subsequently developed widespread urticaria and oedema of the lower limbs, and his antithrombotic was changed to argatroban. Abdominal CT revealed a total occlusion of the vena cava, and the thrombosis extended down in both femoral veins. He underwent unsuccessful endovascular thrombolysis, and began receiving warfarin 3 days later. After 2 months, his oedema had improved, and his HIT tests were negative. A further month of warfarin therapy was proposed. A 24-year-old woman with a history of migraine headaches underwent surgical evacuation of a large intracerebral haemorrhage. She was diagnosed with mild thrombocytopenia, proximal deep vein thrombosis of the left leg, right-sided pulmonary embolism and widespread venous thromboses, and began receiving unfractionated heparin [dosage not stated]. Her platelet count gradually decreased to 15-22 × 109/L, and HIT was suspected [duration of treatment to reaction onset not stated]. Heparin was discontinued, and she was transferred to the stroke unit. Her haemoglobin level was 82-109 g/L and her D-dimer level was 28 mg/L. She was treated with danaparoid sodium, steroids and packed RBC transfusions. Ten days later, she was moved to a rehabilitation unit. Her condition was stable, and she had a platelet count of 184 × 109/L. No further progression of thrombosis was seen. After 3 weeks, she was switched to warfarin. Lassila R, et al. Practical viewpoints on the diagnosis and management of heparininduced thrombocytopenia. Seminars in Thrombosis and Hemostasis 37: 328-36, 803060489 No. 3, Apr 2011 - Finland
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Reactions 24 Sep 2011 No. 1370
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