Thrombocytopenia is not a contraindication to thrombolytic therapy in patients with HIT. Streptokinase (Fiessinger et al., 1984; Cohen et al., 1985; Bounameaux et al., 1986; Cummings et al., 1986; Mehta et al., 1991), urokinase (Leroy et al., 1985; Krueger et al., 1985; Clifton and Smith, 1986), and tissue plasminogen activator (t-PA) (Dieck et al., 1990; Schiffman et al., 1997) have been used both systemically and by local infusion (Quinones-Baldrich et al., 1989). In patients at high bleeding risk, an ultra-low-dose t-PA (2 mg/h over 12 h) was successfully applied without bleeding complications (Olbrich et al., 1998). As thrombin generation is not inhibited by thrombolysis, concomitant non-heparin anticoagulation should be given, in reduced dose, until the fibrinolytic effects have waned.
Recommendation. Regional or systemic pharmacological thrombolysis should be considered as a treatment adjunct in selected patients with limb-threatening thrombosis or pulmonary embolism with severe cardiovascular compromise (grade 2C).
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