Prophylaxis of Venous Thromboembolism

Patients with a previous history of HIT may require an alternative anticoagulant to prevent venous thromboembolism if they require prolonged bed rest and/or surgery or become pregnant. UFH cannot be used, particularly during the first 1 or 2 mo after the onset of HIT when HIT antibodies still circulate. Thereafter, although HIT antibodies are usually undetectable, and the risk of recurrent HIT is possibly relatively low (Warkentin and Kelton, 2001), most physicians are understandably reluctant to re-administer heparin in this situation.

Danaparoid is an effective and convenient drug for the prevention of venous thromboembolism in patients with prior HIT. In the compassionate-use program, 390 patients received danaparoid, 750 U by sc injection, usually twice daily for DVT prophylaxis for many postoperative settings, including general, gynecological, neurological, cancer, and organ transplant surgery. A high rate of success was observed (Magnani, 1997; Ortel and Chong, 1998).

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