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Previous Volume 344:1286-1292 April 26, 2001 Number 17 Next

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ABSTRACT

Background Heparin-induced thrombocytopenia is a relatively common antibody-mediated drug reaction. We studied the temporal relation between previous or current heparin therapy and the onset of heparin-induced thrombocytopenia.

Methods We examined the time between the start of heparin therapy and the onset of thrombocytopenia in 243 patients with serologically confirmed heparin-induced thrombocytopenia. We also investigated the persistence of circulating heparin-dependent antibodies by performing a platelet serotonin-release assay and an assay for antibodies against platelet factor 4. The outcome in seven patients who had previously had an episode of heparin-induced thrombocytopenia and were later treated again with heparin was also examined.

Results A fall in the platelet count beginning four or more days after the start of heparin therapy occurred in 170 of the 243 patients (70 percent); in these patients, a history of previous heparin treatment did not influence the timing of the onset of thrombocytopenia. In the remaining 73 patients (30 percent), the onset of thrombocytopenia was rapid (median time of onset, 10.5 hours after the start of heparin administration); all these patients had been treated with heparin within the previous 100 days. During recovery from thrombocytopenia, heparin-dependent antibodies in the serum fell to undetectable levels at a median of 50 to 85 days, depending on the assay performed. In the seven patients who were given heparin again after the disappearance of heparin-dependent antibodies, a new episode of heparin-induced thrombocytopenia did not occur.

Conclusions Heparin-induced thrombocytopenia can begin rapidly in patients who have received heparin within the previous 100 days. Heparin-dependent antibodies do not invariably reappear with subsequent heparin use.

Source Information

From the Hamilton Regional Laboratory Medicine Program, Hamilton Health Sciences Corporation; and the Department of Pathology and Molecular Medicine and Department of Medicine, Faculty of Health Sciences, McMaster University — both in Hamilton, Ont., Canada.

Address reprint requests to Dr. Warkentin at the Hamilton Regional Laboratory Medicine Program, Hamilton Health Sciences Corp., General Site, 237 Barton St. E., Hamilton, ON L8L 2X2, Canada.

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