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Heparine induced thrombocytopenia

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https://www.readbyqxmd.com/read/28218620/endothelial-antigen-assembly-leads-to-thrombotic-complications-in-heparin-induced-thrombocytopenia
#1
Vincent Hayes, Ian Johnston, Gowthami M Arepally, Steven E McKenzie, Douglas B Cines, Lubica Rauova, Mortimer Poncz
Heparin-induced thrombocytopenia (HIT) is a prothrombotic disorder initiated by antibodies against complexes between human platelet factor 4 (hPF4) and heparin. A better understanding of the events that initiate the prothrombotic state may improve approaches to antithrombotic management. Here, we visualized thrombus formation in an in vivo murine model and an endothelialized microfluidic system that simulate the pathogenesis of HIT. hPF4 released from platelets predominantly bound to peri-injury endothelium and formed HIT antigenic complexes that were dissociated by heparin...
February 20, 2017: Journal of Clinical Investigation
https://www.readbyqxmd.com/read/28182804/medical-and-economic-burden-of-heparin-induced-thrombocytopenia-a-retrospective-nationwide-inpatient-sample-nis-study
#2
Ranjan Pathak, Vijaya Raj Bhatt, Paras Karmacharya, Madan Raj Aryal, Anthony A Donato
In recent years, US hospitals have switched from use of unfractionated heparin to use of low-molecular-weight heparin, which is associated with lower risk of heparin-induced thrombocytopenia (HIT). In the study reported here, we retrospectively searched the Nationwide Inpatient Sample (NIS) for patients who were at least 18 years old and received a diagnosis of HIT between 2009 and 2011. Our goal was to get an updated perspective on the incidence and economic impact of HIT. We calculated the incidence of HIT overall and in subgroups of patients who underwent cardiac, vascular, or orthopedic surgery...
February 2017: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/28177337/free-flap-loss-caused-by-heparin-induced-thrombocytopenia-and-thrombosis-hitt-a-case-report-and-literature-review
#3
E Segna, A R Bolzoni, C Baserga, A Baj
Heparin-induced thrombocytopenia and thrombosis (HITT) represents a dramatic condition that is difficult to diagnose because of nuanced clinical presentation. Therefore, in every case of microvascular thrombosis during heparin-therapy prompt suspicion about HITT is necessary to avoid flap necrosis. We present a case of HITT which, as the 8 other articles reviewed, clearly shows that HITT is difficult to diagnose and complex to manage. Microvascular reconstruction is the first choice in head and neck reconstruction; unfortunately, dramatic outcomes in free flap surgery due to unpredictable thrombotic events are still reported in the English literature...
December 2016: Acta Otorhinolaryngologica Italica
https://www.readbyqxmd.com/read/28156206/heparin-induced-thrombocytopenia-presenting-as-unilateral-lower-limb-paralysis-following-lumbar-spine-surgery-case-report
#4
Brandon W Smith, Jacob R Joseph, Paul Park
Heparin-induced thrombocytopenia (HIT) is a state of thrombocytopenia with a paradoxically elevated thrombotic potential after exposure to heparin. Severe cases can present with multiorgan involvement with direct and secondary effects. Although HIT has been reported following other surgeries, to the authors' knowledge there has not been a report of HIT after spinal surgery. The present case details the course of a patient who underwent elective lumbar surgery followed by delayed presentation of shortness of breath due to multiple pulmonary embolisms and right lower-extremity paralysis due to extensive iliofemoral clot burden with acute compartment syndrome...
February 3, 2017: Journal of Neurosurgery. Spine
https://www.readbyqxmd.com/read/28152960/appropriateness-of-testing-for-heparin-induced-thrombocytopenia-in-hospitalized-patients
#5
Debasmita Saha, Gresa Ajeti, Brandon Bair, Karen Hook, Enrique Ballesteros, Lisa Holle
: 252 Background: Heparin induced thrombocytopenia (HIT) is a devastating thrombotic complication of heparin therapy and occurs in 0.2 to 5% of patients receiving heparin products and is a clinicopathologic diagnosis. The American Society of Hematology Guidelines, recommend the use of the "4Ts" scoring system to determine the pre-test probability of suspected cases. Also, a presumptive clinical diagnosis of HIT must be followed by immediate cessation of all forms of heparin and initiation of alternate anticoagulation...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28118750/characterization-of-pf4-heparin-complexes-by-photon-correlation-spectroscopy-and-zeta-potential
#6
Sabrina Bertini, Jawed Fareed, Laura Madaschi, Giulia Risi, Giangiacomo Torri, Annamaria Naggi
Heparin-induced thrombocytopenia (HIT) is associated with antibodies to complexes between heparin and platelet factor 4 (PF4), a basic protein usually found in platelet alpha granules. Heparin-induced thrombocytopenia antibodies preferentially recognize macromolecular complexes formed between positively charged PF4 and polyanionic heparins over a narrow range of molar ratios. The aim of this work was to study the complexes that human PF4 forms with heparins from various species, such as porcine, bovine, and ovine; heparins from various organs, such as mucosa and lung; and different low-molecular-weight heparins (LMWHs) at several stoichiometric ratios to evaluate their sizes and charges by photo correlation spectroscopy and zeta potential measurements...
January 1, 2017: Clinical and Applied Thrombosis/hemostasis
https://www.readbyqxmd.com/read/28063456/normal-saline-versus-heparin-for-patency-of-central-venous-catheters-in-adult-patients-a-systematic-review-and-meta-analysis
#7
Lei Zhong, Hai-Li Wang, Bo Xu, Yao Yuan, Xin Wang, Ying-Ying Zhang, Li Ji, Zi-Mu Pan, Zhan-Sheng Hu
BACKGROUND: Heparin saline (HS) is theoretically superior to normal saline (NS) for maintaining the patency of central venous catheters (CVCs), but the comparative efficacy of them remains controversial. The aim of this systematic review and meta-analysis was to assess the efficacy of NS versus HS in the maintenance of the patency of CVCs in adult patients. METHODS: We searched PubMed, Embase and the Cochrane library databases. Randomized controlled trials (RCTs) evaluating the use of NS vs...
January 8, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/28057952/direct-thrombin-inhibitor-resistance-and-possible-mechanisms
#8
Maria Cardinale, Michael Ha, Michael H Liu, David P Reardon
Objective: To report 3 cases in which doses of bivalirudin higher than commonly used in clinical practice were required in order to achieve therapeutic anticoagulation as monitored by the activated partial thromboplastin time (aPTT). Case Summary: The medical records of 3 patients who required large doses of bivalirudin to remain therapeutic were thoroughly reviewed. In all 3 patients, bivalirudin was initiated at a rate appropriate for the patients' renal function and titrated using a nurse-driven protocol with recommended dose adjustments based on aPTT...
December 2016: Hospital Pharmacy
https://www.readbyqxmd.com/read/28052584/activated-platelet-derived-and-leukocyte-derived-circulating-microparticles-and-the-risk-of-thrombosis-in-heparin-induced-thrombocytopenia-a-role-for-pf4-bearing-microparticles
#9
Elena Campello, Claudia M Radu, Elena Duner, Anna M Lombardi, Luca Spiezia, Raffaele Bendo, Silvia Ferrari, Paolo Simioni, Fabrizio Fabris
BACKGROUND: Though the presence of platelets-derived microparticles (MPs) have previously been described in heparin-induced thrombocytopenia (HIT), the mechanism of thrombosis in HIT remains poorly understood. We aimed to assess the presence and origin of MPs in patients with HIT and their possible contribution to HIT with thrombosis (HITT). METHODS: Forty-five patients with HIT and 45 matched hospitalized patients with not confirmed HIT (HIT-negative) were enrolled...
January 3, 2017: Cytometry. Part B, Clinical Cytometry
https://www.readbyqxmd.com/read/28052306/laboratory-monitoring-of-parenteral-direct-thrombin-inhibitors
#10
Elizabeth M Van Cott, A Joshua Roberts, William E Dager
Argatroban and bivalirudin are parenteral direct inhibitors of the activity of thrombin, but, unlike heparin, can inhibit both soluble as well as clot-bound thrombin. These agents do not require antithrombin as a cofactor for activity. The parenteral direct thrombin inhibitors (DTIs) can be used in a variety of settings, including heparin-induced thrombocytopenia (HIT) or an allergy to heparin, and patients requiring anticoagulation for an invasive cardiovascular intervention. Both agents have a relatively short half-life in patients without organ system failure and are typically administered by continuous infusion...
January 4, 2017: Seminars in Thrombosis and Hemostasis
https://www.readbyqxmd.com/read/28043990/low-dose-bivalirudin-anticoagulation-for-lung-transplantation-with-extracorporeal-membrane-oxygenation-in-a-patient-with-acute-heparin-induced-thrombocytopenia
#11
Andreas Koster, Jost Niedermeyer, Jan Gummert, Andre Renner
A patient scheduled for lung transplantation needed veno-venous extracorporeal membrane oxygenation (ECMO) and developed acute heparin-induced thrombocytopenia (HIT). After 21 days on ECMO support, lung transplantation was successfully performed using veno-arterial ECMO with bivalirudin anticoagulation. The target activating clotting time values of 160-180 s resulted in low bivalirudin infusion rates of 0.1 mg/kg/h. Diffuse bleeding stopped quickly after ending the continuous bivalirudin infusion.
January 2, 2017: European Journal of Cardio-thoracic Surgery
https://www.readbyqxmd.com/read/28040771/transplantation-in-a-patient-on-extracorporeal-membrane-oxygenation-with-infective-endocarditis-pericarditis-and-heparin-induced-thrombocytopenia
#12
Eunise Chen, Nicholas Clarke, Lynn Huffman, Matthias Peltz
Heart failure patients with pacemaker or defibrillator-associated endocarditis in cardiogenic shock have few treatment options. We present a case of an INTERMACS I patient who developed device infection, sepsis, bacterial pericarditis and heparin-induced thrombocytopenia. The patient was stabilized with extracorporeal membrane oxygenation and successfully transplanted.
December 31, 2016: Interactive Cardiovascular and Thoracic Surgery
https://www.readbyqxmd.com/read/28034871/how-i-evaluate-and-treat-thrombocytopenia-in-the-intensive-care-unit-patient
#13
REVIEW
Andreas Greinacher, Sixten Selleng
Multiple causes (pseudothrombocytopenia, hemodilution, increased consumption, decreased production, increased sequestration, and immune-mediated destruction of platelets) alone or in combination make thrombocytopenia very common in intensive care unit (ICU) patients. Persisting thrombocytopenia in critically ill patients is associated with, but not causative of, increased mortality. Identification of the underlying cause is key for management decisions in individual patients. While platelet transfusion might be indicated in patients with impaired platelet production or increased platelet destruction, it could be deleterious in patients with increased intravascular platelet activation...
December 29, 2016: Blood
https://www.readbyqxmd.com/read/28031678/a-case-of-heparin-induced-thrombocytopenia-type-2-after-repair-of-juxtarenal-abdominal-aortic-aneurysm
#14
Jun Watanabe, Kengo Nishimura, Shigeto Miyasaka, Keisuke Morimoto, Takafumi Hamasaki, Shingo Ishiguro
Heparin-induced thrombocytopenia (HIT) is still a relatively uncommon condition and it is not well known how to administer argatroban during continuous hemodiafiltration (CHDF). A 72-year-old man required CHDF with heparin because of the oliguria and hyperpotassemia directly after the open repair of a juxtarenal abdominal aortic aneurysm. As the postoperative blood platelet count dropped and there was a thrombus in the CHDF circuit, HIT was suspected and nafamostat mesilate, but not heparin, was immediately administered for CHDF...
December 2016: International Journal of Angiology: Official Publication of the International College of Angiology, Inc
https://www.readbyqxmd.com/read/28012249/inappropriate-documentation-of-heparin-allergy-in-the-medical-record-because-of-misdiagnosis-of-heparin-induced-thrombocytopenia-frequency-and-consequences
#15
C M McMahon, Y C Tanhehco, A Cuker
: Essentials Misdiagnosis of heparin-induced thrombocytopenia (HIT) may be associated with adverse outcomes. We conducted a study of patients with a heparin allergy in the chart due to misdiagnosis of HIT. 42% of patients with a heparin allergy due to suspected HIT were clearly HIT-negative. 68% were unnecessarily treated with an alternative anticoagulant, 66% of whom had major bleeding. SUMMARY: Background It is recommended that heparin be added to the allergy list of patients with heparin-induced thrombocytopenia (HIT)...
November 7, 2016: Journal of Thrombosis and Haemostasis: JTH
https://www.readbyqxmd.com/read/28007287/cross-reactivity-between-heparin-and-danaparoid-antibodies-in-cardiac-surgery
#16
Thibault Ronchard, Erwan Salaun, Alexis Theron, Dominique Grisoli, Nicolas Jaussaud, Frédéric Collart, Gilbert Habib, Laurence Camoin-Jau
Management of heparin-induced thrombocytopenia (HIT) entails cessation of heparin and initiation of a nonheparin parenteral anticoagulant such as danaparoid. Danaparoid cross-reactivity with HIT antibodies is an uncommon complication of treatment of HIT. We report the case of confirmed HIT and in vivo cross-reactivity with danaparoid, complicating severe sepsis due to an infectious endocarditis treated by cardiac surgery.
January 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/28005139/-heparin-induced-thrombocytopenia-type%C3%A2-ii-hit%C3%A2-ii-a%C3%A2-medical-economic-view
#17
R Riedel, A Schmieder, A Koster, S Kim, G Baumgarten, J C Schewe
BACKGROUND: In the context of inpatient and increasingly ambulatory thrombosis prophylaxis, heparins have been recognised as standard therapy for decades. In addition to the therapeutic benefit, therapy with heparins also entails the risk of undesirable side effects, such as bleeding and thrombocytopenia. Heparin-induced thrombocytopenia (HIT II) is deemed a serious side effect. AIM: In the following work, HIT II is subjected to a medico-economic consideration (treatment, pharmaceuticals, subsequent costs due to possible complications) and, with regard to a possible HIT II prophylaxis, aspects of increasingly respected patient safety are also considered...
December 22, 2016: Medizinische Klinik, Intensivmedizin und Notfallmedizin
https://www.readbyqxmd.com/read/27986695/acute-oxygenator-failure-a-new-presentation-of-heparin-induced-thrombocytopenia-in-a-patient-undergoing-venovenous-extracorporeal-membrane-oxygenation-support
#18
Robert A Ratzlaff, Juan G Ripoll, Lena L Kassab, Jose L Diaz-Gomez
A 58-year-old man with medical history of thrombocytopenia was admitted to an outside hospital for a 6-day history of worsening dyspnoea requiring mechanical ventilator support. He was transferred to our institution for extracorporeal membrane oxygenation (ECMO) given his refractory hypoxaemia. On arrival, H1N1 influenza virus was confirmed and all measures to improve oxygenation were ineffective. Thus, the decision was made to start venovenous (VV)-ECMO. Although a low baseline platelet count was recognised (60-70×10(9)/L), a sudden further decrease occurred (30×10(9)/L) and platelet transfusion was initiated...
December 16, 2016: BMJ Case Reports
https://www.readbyqxmd.com/read/27970391/tct-216-bivalrudin-vs-argatroban-for-treatment-of-heparin-induced-thrombocytopenia-a-meta-analysis
#19
Poonam Velagapudi, Mohit Turagam, Mayank Mittal, Natraj Katta, Harsh Agrawal, Kul Aggarwal, J Dawn Abbott
No abstract text is available yet for this article.
November 1, 2016: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/27956417/effects-of-oritavancin-on-coagulation-tests-in-the-clinical-laboratory
#20
Adam Belley, Richard Robson, John L Francis, Dorothy M Adcock, Stefan Tiefenbacher, Christopher M Rubino, Greg Moeck, David Sylvester, Michael N Dudley, Jeffery Loutit
Previous studies have shown that some lipoglycopeptide and lipopeptide antimicrobial agents may cause falsely elevated values for some phospholipid-dependent coagulation tests. The effect of oritavancin, a lipoglycopeptide antibiotic, on coagulation test results was explored using pooled human plasma samples spiked with drug and in a clinical study after an infusion of a single 1,200-mg intravenous dose of oritavancin in normal healthy volunteers. Pooled plasma with oritavancin added ex vivo showed concentration-dependent prolongation of prothrombin time/international normalized ratio (PT/INR), activated partial thromboplastin time (aPTT), and dilute Russell viper venom time (DRVVT) test results...
February 2017: Antimicrobial Agents and Chemotherapy
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