RESUMO
Type II heparin-induced thrombocytopenia (HIT) is a potentially severe adverse effect of heparin treatment triggered by an immune response. Although most cases occur in patients receiving unfractioned heparin, HIT can also arise after low-molecular-weight heparin (LMWH). We report a case of HIT in a postoperative orthopedic 75-year-old woman in treatment with LMWH (nadroparin) complicated by pulmonary embolism and treated successfully with recombinant hirudin. Early recognition and proper treatment are fundamental for the management of this life-threatening disorder.
Assuntos
Fibrinolíticos/efeitos adversos , Nadroparina/efeitos adversos , Embolia Pulmonar/induzido quimicamente , Trombocitopenia/induzido quimicamente , Idoso , Anticorpos/sangue , Feminino , Fibrinolíticos/imunologia , Fraturas Ósseas/cirurgia , Hirudinas , Humanos , Nadroparina/imunologia , Procedimentos Ortopédicos , Contagem de Plaquetas , Embolia Pulmonar/sangue , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/tratamento farmacológico , Embolia Pulmonar/imunologia , Proteínas Recombinantes/uso terapêutico , Trombocitopenia/sangue , Trombocitopenia/tratamento farmacológico , Trombocitopenia/imunologia , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
Heparin-induced thrombocytopenia (HIT) is a severe adverse effect of heparin therapy. Although most cases occur in patients receiving unfractionated heparin, HIT can arise in venous thrombosis prophylaxis with a low-molecular-weight heparin (LMWH). We report an uncommon case of HIT in a postoperative orthopedic patient associated with LMWH (nadroparin), complicated by deep venous thrombosis, pulmonary embolism, and disseminated intravascular coagulation, treated successfully with recombinant hirudin and immunoglobulin therapy.
Assuntos
Coagulação Intravascular Disseminada/etiologia , Nadroparina/efeitos adversos , Embolia Pulmonar/etiologia , Trombocitopenia/induzido quimicamente , Artroplastia de Quadril , Coagulação Intravascular Disseminada/diagnóstico , Feminino , Humanos , Imunoglobulina G/imunologia , Pessoa de Meia-Idade , Nadroparina/imunologia , Ativação Plaquetária , Complicações Pós-Operatórias , Embolia Pulmonar/diagnóstico , Trombocitopenia/imunologia , Trombose/prevenção & controle , Tomografia Computadorizada Espiral , Ultrassonografia , Trombose Venosa/diagnóstico , Trombose Venosa/etiologiaRESUMO
Delayed hypersensitivity to heparins and heparinoïd is a problem for prophylaxis of thrombo embolic diseases. The hirudins did not seem to have any cross-reactivity with the two others groups of anticoagulants. We present two clinical cases of delayed type reactions to heparins and heparinoïd and we reviewed the literature about adverse reactions to low molecular weight heparins and the alternative possibilities.