Sir,
We enjoyed reading this article by D. Kejariwal. Heparin-induced thrombocytopenia is a rare, but life- and limb-threatening complication. The recognition of such a problem has been well
documented in the literature.1
The author has correctly mentioned that this problem is under-diagnosed in
orthopaedic practice. In light of increasing use of low–molecular-weight
heparin as a thromboprophylactic agent, we orthopaedic surgeons should be
fully aware of the potential side–effects of the drug.
According to the British National Formulary (BNF),2 it is recommended
that platelet counts are monitored for patients receiving heparin
(including low-molecular-weight heparins) for longer than five days. However, the above recommendation is not strictly adhered to, due either to a lack
of awareness of the potential complication of thrombocytopenia, or the
rarity of such a problem; hence it is often overlooked.
This particular case highlights the importance of monitoring platelets
in patients receiving low–molecular–weight heparin, hence the
urgent need for definite changes in our practice through audit and
implementation of guidelines.
M.A. El Masry, Specialist Registrar,
S. Thambapillay,
Leeds General Infirmary,
Leeds, UK.
1. Warkentin TE, Levine MN, Hirsh J, et al. Heparin-induced
thrombocytopenia in patients treated with low-molecular-weight heparin or
unfractionated heparin. N Engl J Med. 1995 May 18;332(20):1330-5.
2. British National Formulary.
http://www.bnf.org/bnf/extra/current/450062.htm.
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