Trombocitopenia inducida por heparina

La prevalencia de trombocitopenia inducida por heparina (TIH) se encuentra entre 0.1% a 5.0% en pacientes expuestos a la heparina y varía de forma significativa según varios factores de riesgo relacionados con el huésped y el fármaco.[8]Farley S, Cummings C, Heuser W, et al. Prevalence and overtesting of true heparin-induced thrombocytopenia in a 591-bed tertiary care, teaching hospital. J Intensive Care Med. 2019 Jun;34(6):464-71. http://www.ncbi.nlm.nih.gov/pubmed/28978299?tool=bestpractice.com [9]Warkentin TE, Levine MN, Hirsh J, et al. Heparin-induced thrombocytopenia in patients treated with low-molecular-weight heparin or unfractionated heparin. N Engl J Med. 1995 May 18;332(20):1330-5. https://www.nejm.org/doi/full/10.1056/NEJM199505183322003 http://www.ncbi.nlm.nih.gov/pubmed/7715641?tool=bestpractice.com Los pacientes postoperatorios y con traumatismos que reciben heparina representan la incidencia más elevada de TIH (del 1% a 5%), mientras que la TIH es muy infrecuente en pacientes médicos que reciben dosis profilácticas de heparina (<1%) y es extremadamente poco frecuente en pacientes obstétricas (<0.1%).[10]Warkentin TE, Sheppard JA, Moore JC, et al. Laboratory testing for the antibodies that cause heparin-induced thrombocytopenia: how much class do we need? J Lab Clin Med. 2005 Dec;146(6):341-6. http://www.ncbi.nlm.nih.gov/pubmed/16310517?tool=bestpractice.com [11]Warkentin T, Sheppard J, Horsewood P, et al. Impact of the patient population on the risk for heparin-induced thrombocytopenia. Blood. 2000 Sep 1;96(5):1703-8. http://www.ncbi.nlm.nih.gov/pubmed/10961867?tool=bestpractice.com [12]Prandoni P, Siragusa S, Girolami B, et al. The incidence of heparin-induced thrombocytopenia in medical patients treated with low-molecular-weight heparin: a prospective cohort study. Blood. 2005 Nov 1;106(9):3049-54. https://ashpublications.org/blood/article-lookup/doi/10.1182/blood-2005-03-0912 http://www.ncbi.nlm.nih.gov/pubmed/16030191?tool=bestpractice.com [13]Lubenow N, Hinz P, Thomaschewski S, et al. The severity of trauma determines the immune response to PF4/heparin and the frequency of heparin-induced thrombocytopenia. Blood. 2010 Mar 4;115(9):1797-803. https://ashpublications.org/blood/article-lookup/doi/10.1182/blood-2009-07-231506 http://www.ncbi.nlm.nih.gov/pubmed/19965682?tool=bestpractice.com [14]Lindhoff-Last E, Nakov R, Misselwitz F, et al. Incidence and clinical relevance of heparin-induced antibodies in patients with deep vein thrombosis treated with unfractionated heparin or low-molecular-weight heparin. Br J Haematol. 2002 Sep;118(4):1137-42. http://www.ncbi.nlm.nih.gov/pubmed/12199798?tool=bestpractice.com El riesgo de TIH es significativamente más alto con heparina no fraccionada en comparación con heparina de bajo peso molecular (HBPM).[9]Warkentin TE, Levine MN, Hirsh J, et al. Heparin-induced thrombocytopenia in patients treated with low-molecular-weight heparin or unfractionated heparin. N Engl J Med. 1995 May 18;332(20):1330-5. https://www.nejm.org/doi/full/10.1056/NEJM199505183322003 http://www.ncbi.nlm.nih.gov/pubmed/7715641?tool=bestpractice.com [15]Martel N, Lee J, Wells PS. Risk for heparin-induced thrombocytopenia with unfractionated and low-molecular-weight heparin thromboprophylaxis: a meta-analysis. Blood. 2005 Oct 15;106(8):2710-5. https://ashpublications.org/blood/article-lookup/doi/10.1182/blood-2005-04-1546 http://www.ncbi.nlm.nih.gov/pubmed/15985543?tool=bestpractice.com [16]Junqueira DR, Zorzela LM, Perini E. Unfractionated heparin versus low molecular weight heparins for avoiding heparin-induced thrombocytopenia in postoperative patients. Cochrane Database Syst Rev. 2017 Apr 21;4:CD007557. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD007557.pub3/full http://www.ncbi.nlm.nih.gov/pubmed/28431186?tool=bestpractice.com [ ] How does low molecular weight heparin compare with unfractionated heparin for avoiding heparin-induced thrombocytopenia in people undergoing surgery?/cca.html?targetUrl=https://cochranelibrary.com/cca/doi/10.1002/cca.1760/fullMostrarme la respuesta​​ Las mujeres parecen tener un riesgo 1.5 a 2 veces superior de padecer TIH en comparación con los varones.[17]Warkentin TE, Sheppard JA, Sigouin CS, et al. Gender imbalance and risk factor interactions in heparin-induced thrombocytopenia. Blood. 2006 Nov 1;108(9):2937-41. https://ashpublications.org/blood/article-lookup/doi/10.1182/blood-2005-11-012450 http://www.ncbi.nlm.nih.gov/pubmed/16857993?tool=bestpractice.com