International Journal of Hematology and Oncology 2023, Vol 33, Num 4 Page(s): 121-127
HEPARIN INDUCED THROMBOCYTOPENIA – THROMBOSIS DUE TO LOW MOLECULAR WEIGHT HEPARIN IN ORTHOPEDIC PATIENTS

Dede ŞİT1, Abdullah ALTINTAŞ2, Ali K. KADİROĞLU3, Hasan KAYABAŞI3, Mehmet SUBAŞI4, Abdurrahman IŞIKDOĞAN5, M. Orhan AYYILDIZ2

1Dicle University, Department of Nephrology, DİYARBAKIR
2Dicle University, Department of Hematology, DİYARBAKIR
3Dicle University, Department of Internal Medicine, DİYARBAKIR
4Dicle University, Department of Orthopaedic Surgery, DİYARBAKIR
5Dicle University, Department of Oncology, DİYARBAKIR

Keywords: Low molecular weight heparins, Thrombocytopenia, Orthopedic patients
Heparin is a drug that is widely used for prophylaxis of thrombosis or treatment in many clinical situations, particularly in surgical clinics and Heparin-induced thrombocytopenia (HIT) is the most important and most frequent druginduced and immun mediated thrombocytopenia in patients receiving heparin, and has significant morbidity and mortality An early, transient, and mild thrombocytopenia is seen in many patients after initiation of heparin. Heparin induced thrombocytopenia is caused by IgG antibodies that recognize multimolecular complexes of platelet factor 4 (PF4) and heparin. Many studies suggest that up to 8% of heparinized patients develops the HIT antibodies, approximately 1–5% develops HIT with thrombocytopenia, and at least one-third of cases develops thrombosis. In addition thrombosis in HIT is associated with a mortality rate of approximately 20–30%. This complication not only ocur with U Fractioned Heparin (UFH) treatment but also with low molecular weight heparine therapy. In recent study, thrombocytopenia associated with low molecular weight heparins (LMWH) was evaluated prospectively in 340 orthopedic patients who received LMWH for prophylaxis during elective surgery. HIT developed in only 1.2% patients (4/340) and femoral vein thrombosis occurs in 1 patient with HIT. Platelet count recovery was seen in 4 patients after LMWH cessation. In conclusion, HIT is not only a common but also a serious complication of heparin therapy with a high rate of morbidity and mortality. In addition it does not seen only by intravenous/subcutaneous UFH but also by subcutaneous LMWH therapy and the clinicians must be aware of this syndrome in their heparin receiving patients.