Heparin-induced thrombocytopenia (HIT) together with simultaneously occurring thromboembolism
is a serious complication of heparin treatment. At present an immunologic cause of
this side effect of heparin is equivocally accepted. However, further anticoagulation
of these patients is still debated. The present article summarizes the treatment of
20 patients with such complications. Two of these patients did not develop thrombocytopenia
but presented cutaneous allergy or necrosis. All patients were treated either with
intravenous heparinoid (Orgaran) or with low-molecular-weight heparin without/with
simultaneous intravenous high-dose immunoglobulins or with intravenous r-hirudin.
Based on these experiences the treatment of choice depends at present on the availability
of the anticoagulants and on the local experience with the different anticoagulants.
In the future r-hirudins and other nonheparin thrombin inhibitors may become the drugs
of choice in this indication. Surgical intervention has to be considered additionally.
Heparin-induced thrombocytopenia - thromboembolism - heparinoid - r-hirudin
