English abstract
Heparin is one of the most frequently used anticoagulants. It is easy to use, but can be associated
with life-threatening side effects. One of these is heparin-induced thrombocytopenia syndrome (HITS), which
develops in about 3–5% of patients exposed to heparin and is associated with thrombosis in 1% of cases. We report
here the successful treatment of five patients with HITS who were treated with alternative anticoagulants namely
danaparoid or hirudin. The median time between their exposure to heparin and onset of symptoms and or signs
was 10.2 days (range 7–14 days). Platelet counts decreased to a mean of 38.4 x 109
/l (12–82 x 109
/l). All five patients
had evidence of thrombosis; four patients had clinical and radiological evidence of pulmonary emboli, one patient
had confirmed deep vein thrombosis (DVT) and one patient had extensive skin necrosis of the thighs and abdomen.
Platelet aggregation test were positive in two patients, inconclusive in one patient and negative in two patients. Two
patients were anticoagulated with danaparoid and three with hirudin until their platelet counts returned to normal
between 4 and 14 days (average 6 days) following the recognition of the syndrome. Our patients had significant
morbidity, but no mortality. Immediate withdrawal of heparin is of paramount importance and introduction of
alternative anticoagulant is necessary in the presence of thrombosis.
