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Neurologic complications in immune-mediated heparin-induced thrombocytopenia

From the Departments of Neurology (Drs. Pohl and Klockgether), Transfusion Medicine (Drs. Pohl, Harbrecht, and Hanfland) and Pathology (Dr. Theuerkauf), Rheinische Friedrich Wilhelms Universität, Bonn; Institute of Immunology and Transfusion Medicine (Dr. Greinacher), Ernst Moritz Arndt Universität Greifswald; and the Rheinische Landesklinik Bonn (Dr. Biniek), Bonn, Germany.

Address correspondence and reprint requests to Dr. C. Pohl, Department of Neurology, University of Bonn, Sigmund-Freud-Straße, D-53105 Bonn, Germany; e-mail: c.pohl{at}uni-Bonn.de

OBJECTIVE: To evaluate neurologic complications in patients with immune-mediated heparin-induced thrombocytopenia (HIT) with respect to incidence, clinical characteristics, outcome, and therapy.

METHODS: One hundred and twenty consecutive patients with immune-mediated HIT were recruited over a period of 11 years and studied retrospectively for the occurrence of neurologic complications. Diagnosis of HIT was based on established clinical criteria and confirmed by detection of heparin-induced antibodies using functional and immunologic tests.

RESULTS: Eleven of the 120 patients (9.2%) presented with neurologic complications; 7 suffered from ischemic cerebrovascular events, 3 from cerebral venous thrombosis, and 1 had a transient confusional state during high-dose heparin administration. Primary intracerebral hemorrhage was not observed. The relative mortality was much higher (Chi-square test, p < 0.01) in HIT patients with neurologic complications (55%) as compared to patients without neurologic complications (11%). The mean platelet count nadir in neurologic patients was 38 ± 25 x 10⁹/l on average, and was lower in patients with fatal outcome compared to those who survived (21 ± 13 x 10⁹/l versus 58 ± 21 x 10⁹/l; p < 0.05, Wilcoxon test). In three patients neurologic complications preceded thrombocytopenia. There was a high coincidence of HIT-associated neurologic complications with other HIT-associated arterial or venous thrombotic manifestations.

CONCLUSION: Neurologic complications in HIT are relatively rare, but associated with a high comorbidity and mortality. HIT-associated neurologic complications include cerebrovascular ischemia and cerebral venous thrombosis. They may occur at a normal platelet count.

Key words: HIT—Stroke—Cerebral venous thrombosis—Transient confusional state.

This article has been cited by other articles:

				U. Harbrecht, B. Bastians, A. Kredteck, P. Hanfland, T. Klockgether, and C. Pohl Heparin-induced thrombocytopenia in neurologic disease treated with unfractionated heparin Neurology, February 24, 2004; 62(4): 657 - 659. [Abstract] [Full Text] [PDF]

				T. E. Warkentin and R. A. Bernstein Delayed-Onset Heparin-Induced Thrombocytopenia and Cerebral Thrombosis after a Single Administration of Unfractionated Heparin N. Engl. J. Med., March 13, 2003; 348(11): 1067 - 1069. [Full Text] [PDF]