The incidence of heparin-induced thrombocytopenia Type II in patients with subarachnoid hemorrhage treated with heparin versus enoxaparin: Clinical article

Grace H. Kim, David K. Hahn, Christopher P. Kellner, Ricardo J Komotar, Robert Starke, Matthew C. Garrett, Jiang Yao, Justin Cleveland, Stephan A. Mayer, E. Sander Connolly

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Object. Heparin-induced thrombocytopenia Type II (HIT II) is a serious complication that occurs in 0.2-3% of patients treated with heparin and is associated with a high risk of thrombotic events. One center recently reported an incidence of HIT II of 15% in a population of patients with aneurysmal subarachnoid hemorrhage (aSAH). Because these patients are typically exposed to heparin during angiography, controversy exists regarding whether prophylaxis with enoxaparin rather than heparin affords any reduction in the risk of developing HIT II. In this study, the authors investigated the effect of heparin compared with enoxaparin on the incidence of HIT II in patients with aSAH. Methods. The authors reviewed the medical records of 300 patients treated for aSAH who received thromboprophylaxis with either heparin or enoxaparin, and identified patients who developed HIT II. The incidences of HIT II in the 2 treatment groups were then compared. Results. One hundred sixty-six patients with aSAH were treated with heparin, and 134 patients were treated with enoxaparin. Sixteen (5.3%) of 300 patients met the diagnostic criteria for HIT II. Of those treated with heparin, 8 (4.8%) of 166 developed HIT II, compared with 8 (6%) of 134 treated with enoxaparin (difference not significant). Conclusions. The authors report a lower incidence of HIT II in patients with aSAH than has previously been reported. The data also suggest that patients with aSAH who receive heparin are at no greater risk of developing HIT II than those who receive enoxaparin. This finding challenges the merit of choosing enoxaparin rather than heparin for thromboprophylaxis in patients with a SAH.

Original languageEnglish
Pages (from-to)50-57
Number of pages8
JournalJournal of Neurosurgery
Volume110
Issue number1
DOIs
StatePublished - Jan 1 2009
Externally publishedYes

Fingerprint

Enoxaparin
Subarachnoid Hemorrhage
Thrombocytopenia
Heparin
Incidence

Keywords

  • Enoxaparin
  • Heparin
  • Heparin-induced thrombocytopenia
  • Subarachnoid hemorrhage

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

The incidence of heparin-induced thrombocytopenia Type II in patients with subarachnoid hemorrhage treated with heparin versus enoxaparin : Clinical article. / Kim, Grace H.; Hahn, David K.; Kellner, Christopher P.; Komotar, Ricardo J; Starke, Robert; Garrett, Matthew C.; Yao, Jiang; Cleveland, Justin; Mayer, Stephan A.; Connolly, E. Sander.

In: Journal of Neurosurgery, Vol. 110, No. 1, 01.01.2009, p. 50-57.

Research output: Contribution to journalArticle

Kim, Grace H. ; Hahn, David K. ; Kellner, Christopher P. ; Komotar, Ricardo J ; Starke, Robert ; Garrett, Matthew C. ; Yao, Jiang ; Cleveland, Justin ; Mayer, Stephan A. ; Connolly, E. Sander. / The incidence of heparin-induced thrombocytopenia Type II in patients with subarachnoid hemorrhage treated with heparin versus enoxaparin : Clinical article. In: Journal of Neurosurgery. 2009 ; Vol. 110, No. 1. pp. 50-57.
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title = "The incidence of heparin-induced thrombocytopenia Type II in patients with subarachnoid hemorrhage treated with heparin versus enoxaparin: Clinical article",
abstract = "Object. Heparin-induced thrombocytopenia Type II (HIT II) is a serious complication that occurs in 0.2-3{\%} of patients treated with heparin and is associated with a high risk of thrombotic events. One center recently reported an incidence of HIT II of 15{\%} in a population of patients with aneurysmal subarachnoid hemorrhage (aSAH). Because these patients are typically exposed to heparin during angiography, controversy exists regarding whether prophylaxis with enoxaparin rather than heparin affords any reduction in the risk of developing HIT II. In this study, the authors investigated the effect of heparin compared with enoxaparin on the incidence of HIT II in patients with aSAH. Methods. The authors reviewed the medical records of 300 patients treated for aSAH who received thromboprophylaxis with either heparin or enoxaparin, and identified patients who developed HIT II. The incidences of HIT II in the 2 treatment groups were then compared. Results. One hundred sixty-six patients with aSAH were treated with heparin, and 134 patients were treated with enoxaparin. Sixteen (5.3{\%}) of 300 patients met the diagnostic criteria for HIT II. Of those treated with heparin, 8 (4.8{\%}) of 166 developed HIT II, compared with 8 (6{\%}) of 134 treated with enoxaparin (difference not significant). Conclusions. The authors report a lower incidence of HIT II in patients with aSAH than has previously been reported. The data also suggest that patients with aSAH who receive heparin are at no greater risk of developing HIT II than those who receive enoxaparin. This finding challenges the merit of choosing enoxaparin rather than heparin for thromboprophylaxis in patients with a SAH.",
keywords = "Enoxaparin, Heparin, Heparin-induced thrombocytopenia, Subarachnoid hemorrhage",
author = "Kim, {Grace H.} and Hahn, {David K.} and Kellner, {Christopher P.} and Komotar, {Ricardo J} and Robert Starke and Garrett, {Matthew C.} and Jiang Yao and Justin Cleveland and Mayer, {Stephan A.} and Connolly, {E. Sander}",
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T1 - The incidence of heparin-induced thrombocytopenia Type II in patients with subarachnoid hemorrhage treated with heparin versus enoxaparin

T2 - Clinical article

AU - Kim, Grace H.

AU - Hahn, David K.

AU - Kellner, Christopher P.

AU - Komotar, Ricardo J

AU - Starke, Robert

AU - Garrett, Matthew C.

AU - Yao, Jiang

AU - Cleveland, Justin

AU - Mayer, Stephan A.

AU - Connolly, E. Sander

PY - 2009/1/1

Y1 - 2009/1/1

N2 - Object. Heparin-induced thrombocytopenia Type II (HIT II) is a serious complication that occurs in 0.2-3% of patients treated with heparin and is associated with a high risk of thrombotic events. One center recently reported an incidence of HIT II of 15% in a population of patients with aneurysmal subarachnoid hemorrhage (aSAH). Because these patients are typically exposed to heparin during angiography, controversy exists regarding whether prophylaxis with enoxaparin rather than heparin affords any reduction in the risk of developing HIT II. In this study, the authors investigated the effect of heparin compared with enoxaparin on the incidence of HIT II in patients with aSAH. Methods. The authors reviewed the medical records of 300 patients treated for aSAH who received thromboprophylaxis with either heparin or enoxaparin, and identified patients who developed HIT II. The incidences of HIT II in the 2 treatment groups were then compared. Results. One hundred sixty-six patients with aSAH were treated with heparin, and 134 patients were treated with enoxaparin. Sixteen (5.3%) of 300 patients met the diagnostic criteria for HIT II. Of those treated with heparin, 8 (4.8%) of 166 developed HIT II, compared with 8 (6%) of 134 treated with enoxaparin (difference not significant). Conclusions. The authors report a lower incidence of HIT II in patients with aSAH than has previously been reported. The data also suggest that patients with aSAH who receive heparin are at no greater risk of developing HIT II than those who receive enoxaparin. This finding challenges the merit of choosing enoxaparin rather than heparin for thromboprophylaxis in patients with a SAH.

AB - Object. Heparin-induced thrombocytopenia Type II (HIT II) is a serious complication that occurs in 0.2-3% of patients treated with heparin and is associated with a high risk of thrombotic events. One center recently reported an incidence of HIT II of 15% in a population of patients with aneurysmal subarachnoid hemorrhage (aSAH). Because these patients are typically exposed to heparin during angiography, controversy exists regarding whether prophylaxis with enoxaparin rather than heparin affords any reduction in the risk of developing HIT II. In this study, the authors investigated the effect of heparin compared with enoxaparin on the incidence of HIT II in patients with aSAH. Methods. The authors reviewed the medical records of 300 patients treated for aSAH who received thromboprophylaxis with either heparin or enoxaparin, and identified patients who developed HIT II. The incidences of HIT II in the 2 treatment groups were then compared. Results. One hundred sixty-six patients with aSAH were treated with heparin, and 134 patients were treated with enoxaparin. Sixteen (5.3%) of 300 patients met the diagnostic criteria for HIT II. Of those treated with heparin, 8 (4.8%) of 166 developed HIT II, compared with 8 (6%) of 134 treated with enoxaparin (difference not significant). Conclusions. The authors report a lower incidence of HIT II in patients with aSAH than has previously been reported. The data also suggest that patients with aSAH who receive heparin are at no greater risk of developing HIT II than those who receive enoxaparin. This finding challenges the merit of choosing enoxaparin rather than heparin for thromboprophylaxis in patients with a SAH.

KW - Enoxaparin

KW - Heparin

KW - Heparin-induced thrombocytopenia

KW - Subarachnoid hemorrhage

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