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Delayed‐onset HIT caused by low‐molecular‐weight heparin manifesting during fondaparinux prophylaxis
Author(s) -
Alsaleh Khalid A.,
AlNasser Sami M. A.,
Bates Shan M.,
Patel Ameen,
Warkentin Theodore E.,
Arnold Donald M.
Publication year - 2008
Publication title -
american journal of hematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.456
H-Index - 105
eISSN - 1096-8652
pISSN - 0361-8609
DOI - 10.1002/ajh.21273
Subject(s) - fondaparinux , heparin , medicine , heparin induced thrombocytopenia , low molecular weight heparin , platelet factor 4 , anticoagulant , platelet , immunology , gastroenterology , anesthesia , thrombosis , venous thromboembolism
Heparin‐induced thrombocytopenia (HIT) is a prothrombotic condition caused by platelet‐activating antibodies that react with platelet factor 4 (PF4)/heparin complexes. Delayed‐onset HIT occurs after heparin is stopped. Fondaparinux, a synthetic pentasaccharide, is thought to be a safe alternative anticoagulant in HIT. We describe a patient with delayed‐onset HIT triggered by low‐molecular‐weight heparin (LMWH) which occurred during fondaparinux prophylaxis and which was complicated by microangiopathic hemolytic anemia. Patient serum contained high‐titer anti‐PF4/heparin antibodies demonstrating heparin‐dependent platelet activation with serial dilutions. Confirmed delayed‐onset HIT with LMWH has not been previously reported. Low dose fondaparinux does not necessarily prevent thrombotic complications of HIT. Am. J. Hematol., 2008. © 2008 Wiley‐Liss, Inc.