[Heparin-induced thrombopenia. Vascular complications in six cases (author's transl)].
The most frequent complication during heparin treatment is hemorrhage from overdosage. Heparin-induced thrombopenia is more rarely observed but is a more serious disorder. Six such cases are reported, of which three were complicated by gangrene of the limbs. Clinical findings are described, together with the methods of detecting the presence of heparin-induced antiplatelet antibodies. The affection becomes evident on the 9th day of treatment by the presence of a thrombopenia and accompanying clinical signs. These may be those of a hemorrhagic syndrome directly related to the thrombopenia, or manifestations of thrombotic lesions. The latter can cause worsening of the condition for which heparin was prescribed, arterial thrombosis of a large vessel, venous thromboses disappearing after interruption of heparin treatment, of distal thrombosis of the microcirculation with a rapidly irreversible onset of gangrene requiring amputation. The lesions are provoked by an immune mechanism and heparin has to be discontinued.