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So, Does Low-Molecular-Weight Heparin Cause Less Heparin-Induced Thrombocytopenia Than Unfractionated Heparin or Not?

Theodore E. Warkentin, MD; Andreas Greinacher, MD
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Affiliations: Hamilton, ON, Canada ,  Greifswald, Germany ,  Dr. Warkentin is a Professor in the Department of Pathology and Molecular Medicine, and in the Department of Medicine, at the Michael G. DeGroote School of Medicine, McMaster University, in Hamilton, ON. He is also Regional Director of Transfusion Medicine at the Hamilton Regional Laboratory Medicine Program, and is a Hematologist at the Hamilton Health Sciences (Hamilton General Site). Dr. Greinacher is Professor and Head of the Department of Transfusion Medicine and Immunology at Ernst-Moritz-Arndt University in Greifswald, Germany.

Correspondence to: Ted Warkentin, MD, Room 1-180A, Hamilton Regional Laboratory Medicine Program, Hamilton Health Sciences (Hamilton General Site), 237 Barton St E. Hamilton, ON L8L2X2 Canada; e-mail: twarken@mcmaster.ca



Chest. 2007;132(4):1108-1110. doi:10.1378/chest.07-1553
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Heparin-induced thrombocytopenia (HIT) is a prothrombotic adverse effect of heparin caused by platelet-activating antibodies that recognize multimolecular complexes of the chemokine platelet factor 4 (PF4) when it is bound to heparin.1 The reduced risk of HIT and HIT-associated thrombosis (HITT) with low-molecular-weight heparin (LMWH) compared with unfractionated heparin (UFH) seems well established. It was demonstrated in a large randomized controlled trial (RCT),2 in several prospective nonrandomized comparisons,34 in metaanalyses of these (and other) studies,56 and also in several retrospective, but large-scale, population-based studies.79 Furthermore, in-study serologic investigations indicate much lower frequencies of anti-PF4/heparin antibody formation with LMWH compared with UFH.23 Finally, there is an underlying biological rationale, as larger, and presumably more immunogenic, PF4-polysaccharide complexes are formed with UFH than with LMWH.10 The case in favor of LMWH vis-à-vis avoiding HIT would seem closed.

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