Heparin, one of the most widely used anticlotting drugs in the world, is not every hospital patient's best friend.
Five percent of people who receive
heparin to prevent blood clots resulting from surgical procedures
develop an allergic reaction called heparin-induced thrombocytopenia
(HIT), an under-diagnosed drug reaction that can result in limb loss or
Each year about 12 million people receive heparin in hospital-related procedures, and as many as 600,000 develop HIT.
"All patients treated with heparin have
the potential to develop HIT, so their platelet counts should be taken
every two to three days, even if they received heparin in the past with
no problems," says Ronald Sacher, MD, director of the UC's Hoxworth
Blood Center. "If the platelet count is down (a sign of damaged blood
cell production), heparin should be stopped immediately and alternate
medications should be given."
For good reason.
According to Dr. Sacher, up to 30 percent
of patients who develop HIT will die, and an additional 10 to 20
percent will require limb amputation. Others will experience
complications like pulmonary embolism, acute thrombotic stroke and
HIT can develop after a patient has used
the drug for five or more consecutive days, or even sooner if the
patient has had previous exposure to heparin.
Heparin's job, which it normally performs
very well, is to keep the blood's clotting process from becoming active
and forming dangerous clots during or following surgical procedures.
But in patients allergic to heparin, the
opposite happens. In a reaction to the heparin, the patient's
antibodies break up the platelets. Their fragments spread throughout
the blood stream with the stickiness of Jell-O and clog smaller
arteries going to fingers, toes, feet and hands.
If the blockages are severe enough to
cause gangrene, surgeons might need to surgically remove the affected
areas to prevent toxins from spreading.
Because of this risk, 20 national
anticoagulation medicine experts, Dr. Sacher among them, have formed
the HIT Working Group. Their mission--to increase diligence in
diagnosis and treatment of HIT through better management.
"Improving outcomes of patients who have
been diagnosed with HIT begins with recognizing symptoms and providing
immediate treatment," says Dr. Sacher.
George Brangers, 60, of Elizabethtown, Ky., knows the risk very well.
Although he had previously received
heparin for cardiac surgery and pacemaker implantation without
suffering side-effects, just days after undergoing a heart transplant
at University Hospital, Brangers was diagnosed with HIT.
He developed intense swelling in both
feet and in his right hand. Surgeons had to take immediate action to
save his life. As a result, Brangers lost both legs below the knee and
part of a thumb and forefinger.
Despite being crippled by HIT, Brangers
is fighting back. Last year he was appointed honorary leader of the
American Heart Association (AHA) Heart Walk.
Brangers and his family and friends also
teamed up to raise nearly $3,000 for the AHA by hosting chili suppers,
and this year he will captain his family's team for the AHA walk.
Despite the risk he ran with heparin
therapy, "Knowing what I know now, I would definitely do it all over
again just to be with my wife, children and grandchildren.