Journal of Research in Pharmacy Practice

Usefulness of Danaparoid sodium in patients with Heparin-induced thrombocytopenia after cardiac surgery

Document Type : Original Article

Authors

. Farzaneh Foroughinia 1
. Fariborz Farsad 2
. Kheirollah Gholami 3
. Somayeh Ahmadi 2

1 Department of Clinical Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran

2 Rajaei Cardiovascular Medical and Research Center, Iran University of Medical Science, Tehran, Iran

3 Department of Clinical Pharmacy, Tehran University of Medical Sciences, Tehran, Iran

Abstract
Objective: Thrombocytopenia is a common problem in cardiovascular surgery patients. 
However, heparin-induced thrombocytopenia (HIT) is a rare but life-threatening complication 
of prophylaxis or treatment with heparin. Prompt management of HIT with an alternative 
anticoagulant is necessary due to the extreme risk of thrombotic complications. Therefore, 
we evaluated the effects of danaparoid in the treatment of HIT in patients with cardiac 
surgery who are at moderate to high risk of HIT.
Methods: A prospective observational study involving 418 postcardiac surgery patients 
who received unfractionated heparin and low-molecular weight heparin was conducted 
in an educational tertiary cardiac care hospital in Iran. All patients were assessed for HIT 
type II based on thrombocytopenia and pretest clinical scoring system, the “4T’s” score. HIT 
patients were treated with 1500–2500 units intravenous bolus danaparoid sodium followed 
by 200–400 units/h for a mean of 5 days. Successful response to danaparoid therapy, defined 
as augmentation in platelet count and improvement of thrombotic events was assessed in 
all patients treated with danaparoid.
Findings: According to pretest clinical score (4T’s), the probability of HIT was high in 
14 (3.3%) patients and intermediate in three ones (0.7%). 15 patients with HIT were 
treated with danaparoid. One death occurred in danaparoid-treated group due to persistent 
thrombocytopenia. The rest of patients were treated successfully with danaparoid without 
any major thrombotic complication.
Conclusion: According to our data and the previous studies’, HIT can be managed 
prosperously with danaparoid in postcardiac surgery patients. However, with the absence of 
any increase in platelet count after 3–5 days of danaparoid therapy and/or the occurrence 
of a new thrombotic event, danaparoid cross-reactivity with heparin should be suspected.

Keywords

Cardiac surgery
danaparoid
heparin-induced thrombocytopenia
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Journal of Research in Pharmacy Practice
Volume 4, Issue 2
Spring 2015
Pages 73-78

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