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Semin Thromb Hemost 2008; 34: 037-047
DOI: 10.1055/s-0028-1086080
© Thieme Medical Publishers

Heparin-Induced Thrombocytopenia Clinical Studies and the Efficacy of Argatroban in Japan

Shigeki Miyata1 , Haruko Yamamoto2 , Masataka Kamei3 , Takeshi Nakatani4 , 5 , Junjiro Kobayashi4 , Tetsu Tsuji6 , Kazuo Minematsu7 , Hitonobu Tomoike8
  • 1Division of Transfusion Medicine, National Cardiovascular Center, Suita, Osaka, Japan
  • 2Department of Clinical Research and Development, National Cardiovascular Center, Suita, Osaka, Japan
  • 3Department of Anesthesiology, National Cardiovascular Center, Suita, Osaka, Japan
  • 4Department of Cardiovascular Surgery, National Cardiovascular Center, Suita, Osaka, Japan
  • 5Department of Organ Transplantation, National Cardiovascular Center, Suita, Osaka, Japan
  • 6Department of Clinical Chemistry, National Cardiovascular Center, Suita, Osaka, Japan
  • 7Cerebrovascular Division, Department of Medicine, National Cardiovascular Center, Suita, Osaka, Japan
  • 8Department of Internal Medicine, National Cardiovascular Center, Suita, Osaka, Japan
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Publication History

Publication Date:
28 October 2008 (online)

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ABSTRACT

Immune-mediated heparin-induced thrombocytopenia (HIT) is a life-threatening side effect of heparin therapy. HIT has been better recognized in Japan since April 2006 when prescribing information on heparin was revised to include HIT. Diagnosis and treatment of HIT in Japan, however, are still problematic because Japanese regulators have not yet approved any laboratory tests or pharmacological intervention for HIT, especially in patients with acute HIT who require surgery with cardiopulmonary bypass (CPB). We report on three specific cases anticoagulated with argatroban for CPB showing the difficulty of anticoagulation management. We review several retrospective studies and a multicenter, prospective cohort study that suggest a lower incidence of HIT in Japan than what is diagnosed in Western countries. This may be due to ethnic factors and/or different clinical practices. We conducted a multicenter, nonrandomized, open-label trial showing the efficacy and safety of argatroban when carefully dosed. From this study we describe a Japanese strategy to diagnose and treat HIT that may be of value elsewhere.

KEYWORDS

Heparin-induced thrombocytopenia - Japanese population - direct thrombin inhibitor - argatroban

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Shigeki MiyataM.D. Ph.D. 

Division of Transfusion Medicine, National Cardiovascular Center

5-7-1 Fujishirodai, Suita-city, Osaka 565-8565, Japan

Email: smiyata@hsp.ncvc.go.jp