The heparin-induced thrombocytopenia and thrombosis syndrome: treatment with intraarterial urokinase and systemic platelet aggregation inhibitors

Heparin-Induced Thrombocytopenia

Heparin's anticoagulation effect makes it the principal component in the immediate treatment of all thrombotic diseases. After hemorrhage, the most important complication of heparin is thrombocytopenia, the decrease in the number of blood platelets. Ten cases of "heparin-induced thrombocytopenia" are described, and guidelines for diagnosing heparin-induced thrombocytopenia in patients who present for cardiac and vascular surgery are given. Methods of treating patients with heparin-induced thrombocytopenia, including use of arachidonic acid derivatives, antiplatelet agents, other anticoagulants, heparinoids, natural and synthetic thrombin inhibitors, hirudin, and defibrinogenation with ancrod, are discussed.

Transcatheter regional urokinase therapy in the management of inferior vena cava thrombosis

PURPOSE

To study the efficacy of local infusion of urokinase (UK) in the treatment of symptomatic inferior vena cava (IVC) thrombosis.

MATERIALS AND METHODS

Eight patients (five men and three women) who ranged in age from 19 years to 75 years (mean, 56 years) with symptomatic IVC thrombosis underwent local catheter-directed infusion of UK with use of up to three access sites. Infrarenal IVC thrombus and iliac vein thrombus was identified in all patients. Four patients had extension of thrombus proximal to the renal veins. Seven of eight patients had at least one risk factor for IVC thrombosis: hypercoagulable state (n = 3), IVC filter (n = 3), malignancy (n = 2), recent surgery (n = 2), and oral contraceptive use (n = 1). No serious procedure-related complications were encountered, although one patient died 5 days after UK therapy of pulmonary failure due to advanced lung cancer. UK was infused for an average of 79 hours (range, 24-140 hours) and a mean total dose of 7.4 million U of UK (range, 2.9-14.4 million U). Adjunctive balloon angioplasty was performed in three patients. No vascular stents were placed. Clinical and/or radiographic follow-up was obtained in all eight patients.

RESULTS

Thrombolysis was successful in seven of eight (88%) IVCs with no or minimal residual thrombus. The remaining seven patients had no lower extremity swelling 2-24 months (mean, 11 months) after the procedure. Three of seven patients had computed tomographic or venographic follow-up (mean, 9 months; range, 1.5-15 months), demonstrating unchanged or improved IVC patency.

CONCLUSIONS

Transcatheter regional infusion of UK for re-establishing venous patency in acute IVC thrombosis appears to be effective with good short-term and mid-term clinical benefit.