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Serological investigation of patients with a previous history of heparin-induced thrombocytopenia who are reexposed to heparin.
[heparin-induced thrombocytopenia]
Heparin
reexposure
despite
a
history
of
previous
heparin-induced
thrombocytopenia
(
HIT
)
can
be
appropriate
if
platelet
-activating
antibodies
are
no
longer
detectable
.
We
determined
the
frequency
,
timing
,
and
magnitude
of
the
antiplatelet
factor
4
(
anti-
PF
4
)
/
heparin
immune
response
(
by
serotonin-release
assay
[
SRA
]
and
enzyme-immunoassay
[
EIA
]
)
,
and
the
frequency
of
recurrent
HIT
in
20
patients
with
previous
HIT
reexposed
to
heparin
4
.
4
years
(
mean
)
post-
HIT
;
17
patients
were
given
heparin
intraoperatively
(
without
postoperative
heparin
)
for
cardiac
/
vascular
surgery
.
One
patient
developed
recurrent
HIT
beginning
7
days
after
cardiac
surgery
,
with
newly
regenerated
HIT
antibodies
exhibiting
strong
heparin-independent
platelet
-activating
properties
.
Intraoperative
heparin
induced
EIA
seroconversion
in
11
/
17
(
65
%
)
patients
(
immunoglobulin
G
[
IgG
]
>
IgA
>
IgM
)
and
SRA
seroconversion
in
8
/
17
(
47
%
)
,
whereas
none
of
3
medical
patients
reexposed
to
heparin
developed
seroconversion
.
Anti-
PF
4
/
heparin
IgG
became
detectable
at
day
7
(
median
)
,
ie
,
no
sooner
than
observed
in
typical-onset
HIT
.
The
high
proportion
of
SRA
positivity
among
EIA-seroconverting
patients
(
8
/
11
[
73
%
]
)
suggests
that
patients
with
previous
HIT
may
be
especially
predisposed
to
forming
recurrent
antibodies
with
platelet
-activating
properties
.
We
conclude
that
among
patients
with
a
previous
history
of
HIT
who
are
reexposed
to
intraoperative
(
but
not
postoperative
)
heparin
,
the
risk
of
recurrent
HIT
appears
to
be
low
,
but
is
possible
if
antibodies
with
strong
heparin-independent
platelet
-activating
properties
are
formed
.
Diseases
Validation
Diseases presenting
"strong heparin-independent platelet-activating properties"
symptom
heparin-induced thrombocytopenia
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