HEPARIN-INDUCED THROMBOCYTOPENIA, THROMBOSIS, AND HEMORRHAGE

Abstract

Patients (22) developed significant thrombocytopenia (5000-96,000/mm3; mean, 29,000/mm3) while receiving prophylactic or therapeutic heparin. Of them, 17 developed serious thrombohemorrhagic complications which accelerated the deaths of 6 and contributed to the late death of 1. Cessation of heparin therapy led to an immediate remission of the thrombohemorrhagic complications and thrombocytopenia, with no patient who was not already moribund dying, once appropriate therapy was instituted. Platelet-count monitoring is recommended for all patients receiving heparin for more than 6 days, with cessation of heparin therapy being mandatory for the successful management of patients with this disorder. Evidence is presented for an immunologic etiology for this disorder.