Comparative Analysis of a French Prospective Series of 144 Patients with Heparin-Induced Thrombocytopenia (FRIGTIH) and the Literature.

BACKGROUND: Heparin-induced thrombocytopenia (HIT) is a rare complication of heparin treatments, and only a few large patient cohorts have been reported. In this study, biological and clinical data from 144 French patients with HIT were analyzed in comparison with the literature. METHODS: The diagnosis of HIT was confirmed in all patients by an immunoassay combined with serotonin release assay. In the literature, only cohorts of at least 20 HIT patients published from 1992 were selected for a comparative analysis. RESULTS: Two-thirds of patients were hospitalized in surgery and most were treated with unfractionated heparin (83.2% vs. 16.8% with low molecular weight heparin only). Thrombotic events in 54 patients (39.7%) were mainly venous (41/54). However, arterial thrombosis was more frequent after cardiac surgery (13.2% vs. 2.4% in other surgeries, p = 0.042) with a shorter recovery time (median = 3 vs. 5 days, p < 0.001). The mortality rate was lower in our series than in the 22 selected published studies (median = 6.3% vs. 15.9%). Three genetic polymorphisms were also studied and homozygous subjects FcγRIIA RR were more frequent in patients with thrombosis (37.8 vs. 18.2% in those without thrombosis, p = 0.03). CONCLUSION: This study shows that the mortality rate due to HIT has recently decreased in France, possibly due to earlier diagnosis and improved medical care. It also confirms the strong association between polymorphism FcγRIIA H131R and thrombosis in HIT.

Open elbow dislocation associated with distal ischemia in children about one case and review of the literature.

Elbow's dislocations of the child are rare injuries. Its associated injuries such as the opening and the distal ischemia are an extreme therapeutic emergency. One case of open elbow dislocation with distal ischemia in a 10-year-old child is reported. In the clinical examination, there is a deformity of the elbow, a wound showing the cartilaginous distal humerus with the brachial artery under tension on the trochlea that creates a beginning distal ischemia and hypoesthesia in the territory of the median nerve. The surgical health care included a careful debridement, a reduction and scanning of the neurovascular bundle of humerus with reappearance of pulses after 45 minutes. After the last follow-up at three months, the child's examination does not show any neurovascular disorder with a steady elbow. The functional prognosis depends mainly on the reduction time, the importance of neurovascular injuries and the skin opening.