Danaparoid Cross Reactivity

Danaparoid is a mixture of non-heparin anticoagulant glycosaminoglycans, predominantly (low-sulfated) heparan sulfate, dermatan sulfate, and chondroitin sulfate (see Chapter 13). About 10-40 of HIT patient sera cross-react in vitro with danaparoid, depending on the assay used (lower cross-reactivity rates by platelet aggregometry, higher rates with fluid-phase PF4 heparin immunoassays) (Vun et al., 1996 Warkentin et al., 2005 Magnani and Gallus, 2006). The question arises as to the in vivo...

Heparininduced Thrombocytopenia And Paradoxical Thrombosis

Heparin-Induced Thrombocytopenia Routine platelet count measurements were not a feature of hospital laboratory practice until the 1970s, and neither the Dartmouth nor Philadelphia surgeons reported thrombocytopenia in their patients with heparin-induced arterial thrombosis. Ironically, the first report of severe heparin-induced thrombocytopenia (HIT) involved a patient who did not develop paradoxical thrombosis. Natelson and coworkers (1969) reported on a 78-yr-old man with prostate...

Rapid Versus Typical Onset of Thrombocytopenia

We will discuss the diagnostic approach to HIT based on the timing of onset of thrombocytopenia, either rapid (< 5 days) or typical (> 5 days) (see Chapter 2). In general, there are two broad pretest probabilities for patients with rapid thrombocytopenia low and high. Patients with low pretest probability for HIT are those who have not recently been exposed to heparin (thus, they would not be expected to have circulating HIT antibodies, or to have generated them so quickly), or who have...

Inzidenz Hit Ii Belzoni

Ahmad S, Haas S, Hoppensteadt DA, Lietz H, Reid U, Bender N, Messmore HL, Misselwitz F, Bacher P, Gaikwad BS, Jeske WP, Walenga JM, Fareed J. Differential effects of clivarin and heparin in patients undergoing hip and knee surgery for the generation of anti-heparin-platelet factor 4 antibodies. Thromb Res 108 49-55, 2003a. Ahmad S, Bacher P, Lassen MR, Hoppensteadt DA, Leitz H, Misselwitz F, Walenga JM, Fareed J. Investigations of the immunoglobulin subtype transformation of...

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Heparin dalteparin enoxaparin danaparoid FIGURE 4 Cross-reactivity of HIT-IgG antibodies with PF4 complexed to heparin-like anticoagulants The fluid-phase EIA was used to assess the degree to which IgG present in HIT sera or plasma bound to PF4 alone, PF4-heparin, PF4-dalteparin (Fragmin), PF4-enoxaparin (Clexane), or PF4-danaparoid (Orgaran). The positive cutoff (dashed line) is three standard deviations above the mean (log transformed) absorbance of the normal samples (triangles) using...

Other Skin Lesions Associated with Heparin Treatment

The bluish, reticulated (network-like), mottled appearance of livedo reticularis was reported in a patient with HIT complicating intravenous UFH given for atrial fibrillation after heart surgery (Gross et al., 1993). This patient also had DIC, microangiopathic peripheral blood abnormalities, and fibrin thrombi noted within small dermal vessels. The livedo appearance results from microvascular thrombosis, with slowing of blood flow and dilation of the horizontally oriented...

Pharmacologic and Pharmacokinetic Considerations in Anticoagulant Selection

The lack of prospective comparative studies between danaparoid, lepirudin, and argatroban precludes definitive conclusions about relative efficacy and safety. However, there are several pharmacological and pharmacokinetic differences that physicians should consider when determining which drug might be preferred in TABLE 3 Main Characteristics of Danaparoid Sodium Mechanism of action, pharmacokinetics Catalyzes the inactivation of factor Xa by AT, and of thrombin (IIa) by AT and HCII...

Acute Systemic Reactions Following Intravenous Bolus Heparin

ASR refers to a variety of symptoms and signs that characteristically begin 5-30 min after an intravenous heparin bolus is given to a patient with circulating HIT antibodies (Nelson et al., 1978 Warkentin et al., 1992, 1994 Popov et al., 1997 Ling and Warkentin, 1998 Warkentin, 2002b Mims et al., 2004) (Table 5 Fig. 3). Only about one quarter of at-risk patients who receive a heparin bolus develop such a reaction. The most common signs and symptoms are fever and chills, hypertension, and...