[Heparin-induced thrombocytopenia with unfractionated heparin. A prospective study of inpatient treatment of internal medicine patients]. / Heparin-induzierte Thrombozytopenien unter nichtfraktioniertem Heparin. Eine prospektive Studie bei stationär behandelten internistischen Patienten.

AIM: To investigate the influence of unfractionated heparin on heparin-induced thrombocytopenia (HIT) type II. PATIENTS AND METHOD: In 162 patients with internal diseases treated therapeutically of prophylactically with unfractionated heparin (heparin sodium, heparin calcium), we carried out a prospective study to determine the incidence of HIT type I and II. 55.6% of the patients were female (n = 90) with an average age of 76.5 years (range: 25 to 96 years) and 44.4% male (n = 72) with an average age of 67.5 years (range: 17 to 93 years). A platelet count was taken regularly before the start of heparin treatment, on the first day of treatment and then every second day from day 5 to 20. Whenever HIT II was suspected, an HIPA test was performed. RESULT: Type I HIT occurred in 10%, type II in 3% of the cases. Two of the 5 patients with type II developed severe thrombotic complications. CONCLUSION: In view of the high incidence of HIT, regular platelet counts should always be carried out in patients receiving heparin treatment.

[Occlusion of finger arteries and thrombotic angiopathy of the retina during adjuvant tamoxifen therapy of a mammary carcinoma]. / Fingerarterienverschlüsse und thrombotische Angiopathie der Retina unter adjuvanter Tamoxifen-Therapie eines Mammakarzinoms.

HISTORY AND CLINICAL FINDINGS: A 57-year-old woman had undergone partial mastectomy with subsequent radiotherapy for cancer of the breast. About 8 weeks after starting adjuvant treatment with tamoxifen (20 mg daily) pain, cooling and livid discoloration developed in her fingers and toes. Skin necroses over finger tips occurred and she was found to have visual field defects and double images. INVESTIGATIONS: There was no clinical or laboratory evidence of recurrence of the breast cancer. Tests of clotting and for inflammatory disease and complement levels were within normal limits. The antinuclear antibody titre was low (1:320) and the measured value of the rheumatoid factor reached the fourfold of normal level. Ophthalmoscopy revealed signs of retinal ischaemia, unilateral papilloedema, reduced visual acuity, visual field and abduction weakness. Duplex sonography and angiography demonstrated multiple occlusions of the finger arteries. TREATMENT AND COURSE: After tamoxifen had been discontinued and prostaglandin E1 administered (40 micrograms over one hour twice daily for 21 days) the symptoms rapidly and markedly improved, the necroses of the finger tips healed and the ophthalmoscopic changes regressed almost completely. CONCLUSION: Tamoxifen, by inducing thrombophilia, can cause thromboembolic occlusions of peripheral arteries, and must in that case be discontinued.