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Similaire à Heparin Induced Thrombocytopenia Handout
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Heparin Induced Thrombocytopenia Handout
- 1. Heparin-Induced Thrombocytopenia: A Case Presentation Darcie Gampetro Pharm.D Candidate 2011 September 2010
- 9. Heparin-Induced Thrombocytopenia Topic Discussion
- 11. Figure taken from Uptodate (see references
Notes de l'éditeur
- Patient has had approximately 2 previous hospital visits in 2010 -pneumonia -acute hypoglycemic episodes BNP-possible CHF/fluid overload Bipap-bi level positive airway pressure
- Phyontadione-vitamin K
- Note the drop from 138 which was her baseline
- PF4-heparin neutralizing protein released by activated platelets Type I is Non immune mediated not associated with increased risk of thrombosis Up to 8% of patients will develop the antibody associated with HIT. 1-5% of patients on heparin will develop HIT with thrombocytopenia
- Thrombotic complications develop in 20-50% of pts
- HIT is difficult to diagnose because medical and surgical pts may have multiple causes for thrombocytopenia
- A score is determined for each category. Scores can range from 0 to 8
- Nadir=low point
- Platelets rise 2-3 days after discontinuing heparin and return to normal with 4 to 10 days Antibodies disappear 2-3 months after cessation of therapy Atypical manifestations:heparin-induced skin necrosis, venous gangrene of limbs, anaphylactic-type reactions
- Including heparin-bonded catheters, heparin flushes and LMWH should be avoided due to cross reactivity Which ones for reduced renal function? Argatroban at standard doses or lepirudin at reduced doses
- First monitor aPTT 4 hours after start of infusion. Draw aPTT at least once daily during treatment—more if renal or hepatic impairment Dose adjustment based on crcl
- Dose reduction based on crcl. Okay for hepatic impairment. Monitor activated clotting time
- Monitor aPTT after 2 hours---adjust dose to get goal aPTT Do not exceed 100 seconds Metabolized by the liver—dose adjust in severe hepatic impairment dose of 0.5 mcg/kg/min
- Is indicated for DVT in conjunction with
- More like type 1, although presence of antibodies is confusing