5. There are more than 100 HIT stories in the Medical Center every year…
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8. Heparin-Induced Thrombocytopenia (HIT): Pathophysiology 1 *Places patient at greater risk from primary thrombotic problem. 1. Adapted from Aster RH. N Engl J Med . 1995;332(20):1374-1376. Formation of PF4-heparin complexes IgG antibody Formation of immune complexes (PF4-heparin-IgG) EC injury PF4 release Platelet activation* Microparticle release Fc receptor Platelet Heparin-like molecules Blood vessel PF4 Heparin
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10. Risk of Thrombosis with HIT After Heparin is Stopped (if an effective alternative is not begun) Warkentin and Kelton. Am J Med 1996;101. Days after isolated HIT recognized 100 90 80 70 60 50 40 30 20 10 0 52.8% 0 2 4 6 10 12 14 16 8 18 22 26 28 30 24 20 Cumulative frequency of thrombosis (%)
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13. HIT Temporal Variants Courtesy of Dr Ahjad AlMahameed Cleveland Clinic, OH. Day 1 Day 4 Day 14 Day 30 Delayed-onset HIT (9 – 40 days) Rapid-onset HIT (hours – days) Typical HIT Mean Day 9 (4 – 14 days) Heparin (re) Exposure THROMBOCYTOPENIA (± THROMBOSIS)
18. Alternative Anticoagulants Approved for HIT in Canada, Europe, Aust. Danaparoid Prophylaxis and Rx of VTE Fondaparinux (pentasac.) PCI (including HIT patients) Bivalirudin FDA-approved for HIT Lepirudin FDA-approved for HIT (also for PCI) Argatroban Indications Drug
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