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Shusterman M, Grassl N, Berger K, De Sancho MT. Prolonged activated partial thromboplastin time after prophylactic-dose unfractionated heparin in the post-operative neurosurgical setting: case series and management recommendations. J Thromb Thrombolysis 2020; 49:153-158. [PMID: 31456167 DOI: 10.1007/s11239-019-01936-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Primary brain tumors, both benign and malignant, pose a high risk of perioperative venous thromboembolism (VTE) due to the development of a prothrombotic state. Perioperative pharmacologic thromboprophylaxis with subcutaneous (SC) unfractionated heparin (UFH) has significantly reduced VTE associated morbidity. Recent reports suggest an association between prolonged activated partial thromboplastin time (aPTT) due to prophylactic SC UFH and increased bleeding risk. We present three patients with normal baseline coagulation parameters in whom pharmacologic thromboprophylaxis with SC UFH resulted in a marked prolongation of the aPTT, leading to adverse outcomes in two patients. These cases demonstrate the uncertain kinetics of SC UFH and effect on aPTT, suggesting the significance of routine aPTT monitoring in high-risk settings. Given the wide variation in presentations of therapeutic or supratherapeutic values of aPTT in the perioperative neurosurgical setting, we propose a practical standardized approach to the evaluation and management of aPTT prolongation following prophylactic SC UFH administration.
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Affiliation(s)
- Michael Shusterman
- Division of Hematology - Oncology, Department of Medicine, Weill Cornell Medicine, New York, NY, USA. .,Division of Hematology-Oncology, Department of Medicine, Weill Cornell Medicine, 520 East 70th Street, Starr Pavilion, 3rd Floor, New York, NY, 10021, USA.
| | - Niklas Grassl
- Division of Hematology - Oncology, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Karen Berger
- Department of Pharmacy, New York-Presbyterian Hospital - Weill Cornell Medical Center, New York, NY, USA
| | - Maria T De Sancho
- Division of Hematology - Oncology, Department of Medicine, Weill Cornell Medicine, New York, NY, USA. .,Division of Hematology-Oncology, Department of Medicine, Weill Cornell Medicine, 1305 York Avenue 7th Floor, New York, NY, 10021, USA.
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Tardy B, Chalayer E, Kamphuisen PW, Ni Ainle F, Verhamme P, Varlet MN, Chauleur C, Rodger M, Merah A, Buchmuller A, Bistervels I, De Sancho MT, Middeldorp S, Bertoletti L. Definition of bleeding events in studies evaluating prophylactic antithrombotic therapy in pregnant women: A systematic review and a proposal from the ISTH SSC. J Thromb Haemost 2019; 17:1979-1988. [PMID: 31402557 DOI: 10.1111/jth.14576] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 06/25/2019] [Accepted: 06/28/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Bernard Tardy
- Inserm CIC 1408, FCRIN-INNOVTE, CHU de Saint Etienne, Saint Etienne, France
| | - Emilie Chalayer
- Inserm CIC 1408, FCRIN-INNOVTE, CHU de Saint Etienne, Saint Etienne, France
| | | | - Fionnuala Ni Ainle
- Department of Haematology, Mater Misericordiae University Hospital Dublin, Dublin, Ireland
| | - Peter Verhamme
- Vascular Medicine and Haemostasis, University of Leuven, Leuven, Belgium
| | - Marie Noelle Varlet
- Department of Gynecology and Obstetrics, University Hospital, Saint-Étienne, University Jean-Monnet, Saint-Étienne, France
| | - Celine Chauleur
- Department of Gynecology and Obstetrics, University Hospital, Saint-Étienne, University Jean-Monnet, Saint-Étienne, France
| | - Marc Rodger
- Department of Medicine, Division of Hematology, The Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada
| | - Adel Merah
- Inserm CIC 1408, FCRIN-INNOVTE, CHU de Saint Etienne, Saint Etienne, France
| | - Andrea Buchmuller
- Inserm CIC 1408, FCRIN-INNOVTE, CHU de Saint Etienne, Saint Etienne, France
- Service de Médecine Vasculaire et Thérapeutique, CHU de St-Etienne, St-Etienne, France
- INSERM, UMR1059, Equipe Dysfonction Vasculaire et Hémostase, Université Jean-Monnet, St-Etienne, France
- FCRIN-INNOVTE, St-Etienne, France
| | - Ingrid Bistervels
- Department of Vascular Medicine, Academic Medical Center, Amsterdam, the Netherlands
| | - Maria T De Sancho
- Department of Medicine, Division of Hematology-Oncology, New York Presbyterian Hospital of Weill Cornell Medical College, New York, NY, USA
| | - Saskia Middeldorp
- Department of Vascular Medicine, Academic Medical Center, Amsterdam, the Netherlands
| | - Laurent Bertoletti
- Inserm CIC 1408, FCRIN-INNOVTE, CHU de Saint Etienne, Saint Etienne, France
- Service de Médecine Vasculaire et Thérapeutique, CHU de St-Etienne, St-Etienne, France
- INSERM, UMR1059, Equipe Dysfonction Vasculaire et Hémostase, Université Jean-Monnet, St-Etienne, France
- FCRIN-INNOVTE, St-Etienne, France
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