By Will Boggs, MD
Patients infected with HIV have an increased risk of developing heparin-induced thrombocytopenia (HIT), according to a report in the November 15th issue of Clinical Infectious Diseases.
"We believe, and our data suggest, any heparin product in the HIV population should be used with caution," Dr. George R. Thompson III from the University of Texas Health Science Center at San Antonio told Reuters Health.
Dr. Thompson and colleagues investigated whether HIT occurs significantly more often in HIV-infected patients than in HIV-uninfected patients.
Thirteen of 53 HIV-infected patients (25%) developed HIT, the authors report, compared with none of 106 HIV-uninfected patients treated with heparin.
Complications of HIT, including thrombosis and bleeding, developed in 5 of the 13 affected HIV-infected patients.
HIT developed somewhat less commonly among patients treated with low molecular weight heparin (LMWH) than among those treated with unfractionated heparin, the investigators say.
"HIV patients are frequently hypercoagulable, and prior to our article empiric anticoagulation for most HIV patients seemed prudent," Dr. Thompson said. "However, our data demonstrate the potential for morbidity if all HIV patients are anticoagulated, with the subsequent development of HIT in a substantial number."
He advised, "The decision to anticoagulate should, therefore, be individualized from patient to patient, and careful attention given to the pros and cons of prescribing versus withholding therapy. When anticoagulation is needed, LMWH seems to be the safer choice."
