Dextran

High molecular weight dextran in high concentrations inhibit platelet function and fibrinogen polymerization; they also inhibit HIT antibody-mediated platelet aggregation (Sobel et al., 1986). However, an RCT (Chong et al., 2001) (see Chapter 13) showed that in patients with severe HIT-associated thrombosis, dextran 70 was less effective therapy than danaparoid. It is unknown whether dextran would provide additional clinical benefit if combined with another anticoagulant. We do not advocate dextran for the management of HIT.

Recommendation. Dextran should not be used as primary therapy for acute HIT complicated by thrombosis (grade 1B).

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