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The influence of the percutaneous closure of atrial septal defect on the occurrence of migraine

study showing that danaparoid sodium for isolated HIT received in low prophylactic doses is associated with a high failure rate compared with patients received lepirudin in APTT-adjusted doses. This speaks in favour of the use of therapeutic-dose danaparoid in both isolated HIT and HITwith PE. Our recent clinical practice has registered nine successfully treated patients diagnosed with PE caused by HIT II. Initial danaparoid sodium (four patients) or lepirudin (three patients) treatment was successful in seven patients. The remaining two fell into the category of full therapeutic dose-danaparoid sodium resistant cases. One of these patients responded positively only upon lepirudin introduction, whereas in the other patient, no effect was produced even by therapeutic lepirudin doses where the remission was achieved only after plasmapheresis. Thus, it has not escaped our notice that the management of patients resistant to initial non-heparin anticoagulants was absolutely neglected, not only in the Guidelines themselves but also in other principal reference sources, though such cases account for a considerable proportion of HIT II patients treated with danaparoid sodium or lepirudin as nonheparin anticoagulants of similar efficacy (9.4% thrombosis rate with danaparoid vs. 7.9% thrombosis rate with lepirudin). Administration of new anticoagulants of bivaluridin and fondaparinux type may even have certain advantages over the standard alternative non-heparin anticoagulants. Hope remains that new guidelines for the diagnosis and treatment of PE will take into account the complexity of both HIT II patients and individualized treatment demands dependent on their specific state of haemostasis, possible accompanying diseases, and the patient’s resistance to initial therapy, with special reference to the application of adjunctive measures, of which plasmapheresis has a proved clinical effect.