Zerebrovaskuläre Komplikationen der Heparininduzierten Thrombozytopenie Typ II (HIT-II)

Zusammenfassung

Die immunologisch bedingte Heparininduzierte Thrombozytopenie Typ II (HIT-II) ist eine nach Heparinexposition auftretende Antikörper-bedingte thrombotische Erkrankung, bei der es zu einer Thrombozytopenie kommt. Etwa die Hälfte der HIT-Patienten entwickelt venöse oder arterielle thrombotische Komplikationen. Als neurologische Komplikationen werden im Zuge der HIT-II vor allem zerebrale Ischämien und Sinus-Hirnvenenthrombosen beobachtet. Zur Sicherung der primär klinischen Diagnose HIT-II stehen als laborchemische Verfahren funktionelle und immunologische Assays zum Antikörpernachweis zur Verfügung. Die Wahrscheinlichkeit für das Auftreten einer HIT-II hängt von der Art des eingesetzten Heparins (LMWH vs. UFH) und individuellen Patienteneigenschaften wie Geschlecht und Grunderkrankung (medizinische vs. chirurgische Patienten) ab. Bei Verdacht auf Vorliegen einer HIT-II muss die Heparingabe sofort beendet und durch eine alternative Antikoagulation zur Verhinderung der Entwicklung oder Ausweitung von thrombotischen Komplikationen ersetzt werden. Wir beschreiben hier den Fall einer Patientin mit HIT-II-assoziierten embolischen zerebralen Ischämien und geben einen Überblick über die aktuelle Literatur zu neurologischen Komplikationen bei HIT-II.

Abstract

Immunologically mediated heparin-induced thrombocytopenia (HIT) is a thrombotic disease caused by antibodies occurring after heparin exposure. Thrombocytopenia occurs within a few days after heparin exposure, about half of HIT-patients develop venous or arterial thrombotic complications. Neurological complications of HIT are mainly ischaemic stroke and sinus vein thrombosis. To ensure the primary clinical diagnosis functional and immunological assays for antibody detection are available. The probability for the occurrence of HIT depends on the nature of heparin employed (LMWH vs. UFH) and individual patient characteristics such as gender and primary disease (medical vs. surgical patients). In the case of suspected HIT heparin administration should be discontinued immediately and replaced by an alternative anticoagulation to prevent the expansion or development of further thrombotic complications. Herein we report a case of a patient suffering from HIT-associated embolic cerebral ischaemic stroke.

Schlüsselwörter

Schlaganfall - Heparin - Thrombozytopenie - HIT2 - Thrombose

Key words

stroke - heparin - thrombocytopenia - HIT - thrombosis

• Literatur

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