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Heparin-induced Thrombocytopenia

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https://www.readbyqxmd.com/read/29678479/hit-or-miss-a-comprehensive-contemporary-investigation-of-laboratory-tests-for-heparin-induced-thrombocytopenia
#1
Emmanuel J Favaloro, Georgia McCaughan, Soma Mohammed, Kun Kan Edwin Lau, Rosalie Gemmell, Lauren Cavanaugh, Dea Donikian, Mayuko Kondo, Timothy Brighton, Leonardo Pasalic
Heparin induced thrombocytopenia (HIT) is a rare but potentially fatal complication of heparin therapy, which in a proportion of patients causes platelet activation and thrombosis. Initial clinical assessment of the likelihood of HIT is facilitated by laboratory testing to confirm or exclude HIT. This prospective investigation was performed over an 18-month period, and has involved testing of over 300 test samples from over 100 consecutive patients. Clinical assessment by 4T score was supplemented by laboratory tests that comprised both immunological [lateral flow ('STiC'), chemiluminescence (AcuStar; HIT-IgG(PF4-H) ), ELISA (Asserachrom HPIA IgG)] and functional assays [SRA, platelet aggregation using whole blood ('Multiplate') and platelet rich plasma ('LTA')]...
April 17, 2018: Pathology
https://www.readbyqxmd.com/read/29677409/is-there-an-association-between-heparin-induced-thrombocytopenia-hit-and-autoimmune-disease
#2
Brent Klinkhammer, Michael Gruchalla
BACKGROUND: Heparin-induced thrombocytopenia (HIT) is a drug-induced, immunoglobulin G medicated autoimmune disorder associated with several negative clinical outcomes including increased morbidity, mortality, and increased medical costs. Previous studies have shown associations between comorbid autoimmune diseases, but there is little known about associations between HIT and autoimmunity. PURPOSE: To provide clinical data to suggest an association between HIT and autoimmunity...
March 2018: WMJ: Official Publication of the State Medical Society of Wisconsin
https://www.readbyqxmd.com/read/29665860/the-use-of-cangrelor-with-heparin-for-left-ventricular-assist-device-implantation-in-a-patient-with-acute-heparin-induced-thrombocytopenia
#3
Yan K Gernhofer, Michael Ross, Swapnil Khoche, Victor Pretorius
BACKGROUND: Optimal anticoagulation strategy for cardiopulmonary bypass (CPB) in end-stage heart failure patients with heparin-induced thrombocytopenia (HIT) requiring left ventricular assist device (LVAD) implantation remains uncertain. Presently, there are no large-scale randomized studies comparing outcomes of alternative anticoagulation strategies for CPB in this patient population. A novel antiplatelet agent - cangrelor, which is a potent P2Y12 inhibitor with robust antiplatelet efficacy, rapid reversibility, and measurable drug effect, has become available since 2015...
April 17, 2018: Journal of Cardiothoracic Surgery
https://www.readbyqxmd.com/read/29661682/absolute-immature-platelet-counts-in-the-setting-of-suspected-heparin-induced-thrombocytopenia-may-predict-anti-pf4-heparin-immunoassay-testing-results
#4
Wei Chen, Jennifer P Ha, Hong Hong, Robert W Maitta
BACKGROUND: Heparin-induced-thrombocytopenia (HIT) is a disease mediated by antibodies to platelet factor 4 (PF4)-heparin complexes. Immature platelet fraction (%-IPF) and absolute immature platelet count (A-IPC) measure newly-released platelets into circulation and can prove useful in differentiating patients with thrombocytopenic presentations due to consumptive or hypoproduction processes. Therefore, we evaluated utility of A-IPC in a cohort of thrombocytopenic patients suspected of HIT...
April 11, 2018: Transfusion and Apheresis Science
https://www.readbyqxmd.com/read/29649767/heparin-induced-thrombocytopenia-a-critical-appraisal-of-clinical-practice-guidelines-with-the-agree-ii-instrument
#5
Ying Wang, Zhi-Kang Ye, Ji-Feng Li, Xiang-Li Cui, Li-Hong Liu
BACKGROUND: Despite the availability of clinical practice guidelines (CPGs), the risk of death or thromboembolic complication associated with heparin-induced thrombocytopenia (HIT) remains high. Our aim was to systematically review the quality of CPGs for HIT and summarize the recommendations. METHODS: CPGs for HIT were systematically searched on PubMed, Embase, guidelines' websites, and Google up to August 6, 2017. Independently, three appraisers assessed the quality of CPGs using the Appraisal of Guidelines for Research & Evaluation II (AGREE II) instrument and extracted the data...
March 27, 2018: Thrombosis Research
https://www.readbyqxmd.com/read/29628468/induction-of-anti-pf4-heparin-antibodies-after-arthroplasty-for-rheumatic-diseases
#6
Kiyoshi Migita, Tomoyuki Asano, Shuzo Sato, Satoru Motokawa
Heparin-induced thrombocytopenia (HIT) is an immune complication of heparin therapy caused by antibodies to complexes of platelet factor 4 (PF4) and heparin. These pathogenic antibodies against PF4/heparin bind and activate cellular FcγRIIa on platelets to induce a hypercoagulable state culminating in thrombosis. Recent studies indicate several conditions, including joint surgery, induce spontaneous HIT, which can occur without exposure to heparin. To determine the real-world evidences concerning the incidences of venous thromboembolism (VTE) after total joint arthroplasty for rheumatic disease, we conducted a multicenter cohort study (J-PSVT) designed to document the VTE and seroconversion rates of anti-PF4/heparin antibody in 34 Japanese National hospital organization (NHO) hospitals...
April 7, 2018: Fukushima Journal of Medical Science
https://www.readbyqxmd.com/read/29622761/simultaneous-pancreas-kidney-transplantation-in-a-patient-with-heparin-induced-thrombocytopenia-on-dabigatran-therapy
#7
Agnieszka Jóźwik, Wojciech Lisik, Jarosław Czerwiński, Maciej Kosieradzki
BACKGROUND New oral anticoagulants like direct thrombin inhibitors are an attractive alternative to vitamin K antagonists as anticoagulation therapy and can be used in heparin-induced thrombocytopenia. They are convenient in low-risk surgery, as there is no need for bridging with heparins. Patients who need urgent major surgery are at similar risk as on warfarin therapy, which, however, is much higher than in elective procedures. Due to their elimination profiles, these drugs are generally contraindicated in patients with severe renal insufficiency...
April 6, 2018: Annals of Transplantation: Quarterly of the Polish Transplantation Society
https://www.readbyqxmd.com/read/29614814/the-role-of-single-molecule-force-spectroscopy-in-unraveling-typical-and-autoimmune-heparin-induced-thrombocytopenia
#8
REVIEW
Van-Chien Bui, Thi-Huong Nguyen
For the last two decades, heparins have been widely used as anticoagulants. Besides numerous advantages, up to 5% patients with heparin administration suffer from a major adverse drug effect known as heparin-induced thrombocytopenia (HIT). This typical HIT can result in deep vein thrombosis, pulmonary embolism, occlusion of a limb artery, acute myocardial infarct, stroke, and a systemic reaction or skin necrosis. The basis of HIT may lead to clinical insights. Recent studies using single-molecule force spectroscopy (SMFS)-based atomic force microscopy revealed detailed binding mechanisms of the interactions between platelet factor 4 (PF4) and heparins of different lengths in typical HIT...
April 2, 2018: International Journal of Molecular Sciences
https://www.readbyqxmd.com/read/29605959/heparin-induced-thrombocytopenia-in-infants-after-heart-surgery
#9
Juma N Abdillah, Qinghua Hu, Xuliang Chen, Xing Chen, Wu Zhou, Wanjun Luo, Lingjin Huang
BACKGROUND:  Heparin-induced thrombocytopenia (HIT) in infants is a rare disorder, and the diagnosis and management of HIT still remains challenging. Argatroban is a synthetic direct thrombin inhibitor (DTI) that is widely used for treating HIT. However, little is known about the efficacy of the activated clotting time (ACT) test in monitoring DTI treatment as an alternative to the routinely used activated partial thromboplastin time (aPTT). METHODS:  Between July 2013 and January 2015, four infants were diagnosed with HIT after surgical correction of congenital anomalies...
April 1, 2018: Thoracic and Cardiovascular Surgeon
https://www.readbyqxmd.com/read/29600212/upper-limb-phlegmasia-cerulea-dolens-secondary-to-heparin-induced-thrombocytopenia-a-case-study
#10
Matthew Gaines, Mike Grant, Simon Robinson, Helene Stevenson
Introduction: Phlegmasia cerulea dolens (PCD) is a rare pathology with a very high morbidity and mortality rate, which usually occurs in the lower limb. There is very little literature available to aid management. Case Report: We present a case of upper limb PCD in a 67-year-old female secondary to heparin-induced thrombocytopenia caused by warfarin bridging. She presented to the orthopedic team with upper limb compartment syndrome from a bleed around a peripherally inserted central catheter, for which she was urgently taken to the theater for fasciotomies...
November 2017: Journal of Orthopaedic Case Reports
https://www.readbyqxmd.com/read/29599195/2-o-3-o-desulfated-heparin-mitigates-murine-chemotherapy-and-radiation-induced-thrombocytopenia
#11
Elizabeth Tkaczynski, Abinaya Arulselvan, John Tkaczynski, Stephen Avery, Liqing Xiao, Beverly Torok-Storb, Kraig Abrams, Narayanam V Rao, Gregory Johnson, Thomas P Kennedy, Mortimer Poncz, Michele P Lambert
Thrombocytopenia is a significant complication of chemotherapy and radiation therapy. Platelet factor 4 (PF4; CXCL4) is a negative paracrine of megakaryopoiesis. We have shown that PF4 levels are inversely related to steady-state platelet counts, and to the duration and severity of chemotherapy- and radiation-induced thrombocytopenia (CIT and RIT, respectively). Murine studies suggest that blocking the effect of PF4 improves megakaryopoiesis, raising nadir platelet counts and shortening the time to platelet count recovery...
April 10, 2018: Blood Advances
https://www.readbyqxmd.com/read/29574610/platelet-response-to-direct-thrombin-inhibitor-or-fondaparinux-treatment-in-patients-with-suspected-heparin-induced-thrombocytopenia
#12
Tiffany K Pon, Anjlee Mahajan, Aaron Rosenberg, Alpesh Amin, Digish Shah, Ian Jenkins, Vineet Gupta, Heather Hofmann, Anthony Bejjani, Richard White
Making a definitive diagnosis of heparin-induced thrombocytopenia (HIT) can be problematic. A prompt platelet rise following treatment has been proposed as a "post-test" criterion for diagnosis. However, the platelet response following discontinuation of heparin and initiation of a recommended alternative anticoagulant remains largely undefined and unstudied. This study aimed to characterize platelet response to initial treatment in patients with a low, intermediate, or high likelihood of having HIT...
March 24, 2018: Journal of Thrombosis and Thrombolysis
https://www.readbyqxmd.com/read/29560388/enoxaparin-induced-skin-necrosis-at-injection-site-after-total-knee-arthroplasty
#13
Max Haffner, Nasser Heyrani, John P Meehan, Mauro Giordani
Enoxaparin is a widely used low-molecular-weight heparin for perioperative thromboembolic prophylaxis. Enoxaparin-induced skin necrosis in the setting of arthroplasty has been rarely reported in the literature with varying outcomes and management decisions. Our patient developed skin necrosis at his injection site and thrombocytopenia 10 days following left total knee arthroplasty surgery and after receiving subcutaneous Lovenox injections postoperatively. The patient was started on an alternative anticoagulation based on a high suspicion for heparin-induced thrombocytopenia and the wound was monitored without surgical debridement...
March 2018: Arthroplasty Today
https://www.readbyqxmd.com/read/29558777/heparin-induced-thrombocytopenia-in-cardiac-surgery-patients
#14
Anna Vittoria Mattioli, Antonio Manenti, Alberto Farinetti
No abstract text is available yet for this article.
March 20, 2018: Seminars in Thrombosis and Hemostasis
https://www.readbyqxmd.com/read/29538017/bivalirudin-dosing-requirements-in-adult-patients-on-extracorporeal-life-support-with-or-without-continuous-renal-replacement-therapy
#15
Elizabeth A Walker, A Joshua Roberts, Erin L Louie, William E Dager
Systemic anticoagulation with unfractionated heparin is standard of care for patients receiving extracorporeal life support (ECLS); however, an alternative anticoagulant may be necessary when challenges with heparin therapy arise. Evidence for alternative anticoagulation in ECLS patients is limited. This retrospective analysis evaluated the dosing and outcomes associated with bivalirudin use in 14 adult ECLS patients. Indications for bivalirudin included heparin-induced thrombocytopenia, heparin resistance, or persistent clotting or bleeding while on heparin...
March 13, 2018: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/29531454/the-fondaparinux-paradox-fondaparinux-related-heparin-induced-thrombocytopenia
#16
Sonali Vadi, Vishal Peshattiwar
Fondaparinux, a pentasaccharide administered for heparin-induced thrombocytopenia (HIT), can lead to the occurrence of thrombocytopenia. This patient underwent aortic stent graft placement for Salmonella paratyphi A-infected abdominal aortic aneurysm. Fondaparinux was administered for anticoagulation that led to a dramatic decline in his platelet counts. Investigations revealed HIT profile, PF4/heparin by particle gel immunoassay to be positive. Fondaparinux, a prescribed anticoagulant for HIT can paradoxically predispose to thrombocytopenia...
February 2018: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/29512619/a-practical-and-case-based-approach-to-thrombocytopenia-in-cardiology-practice
#17
Erman Öztürk, Ferit Onur Mutluer
In cardiology practice, anticoagulation and antiplatelet therapies are essential for most patients. As of yet, there is no high quality evidence regarding these treatments in thrombocytopenic patients, which continues to be an issue. Thrombocytopenia is defined as a platelet count of <150x109/L and is classified as severe when the platelet count is <50x109/L. Pseudothrombocytopenia, drug-induced thrombocytopenia, immune thrombocytopenia, heparin-induced thrombocytopenia, and thrombotic thrombocytopenic purpura are some of the main causes of thrombocytopenia...
March 2018: Türk Kardiyoloji Derneği Arşivi: Türk Kardiyoloji Derneğinin Yayın Organıdır
https://www.readbyqxmd.com/read/29512614/heparin-induced-thrombocytopenia-after-mitraclip-a-case-report
#18
Özge Çetinarslan, Ümit Yaşar Sinan, Emir Barış Ökçün, Cengiz Çeliker, Nuh Nazmi Gültekin
Heparin-induced thrombocytopenia (HIT) and heparin-induced thrombocytopenia and thrombosis are potentially fatal adverse reactions to heparin therapy caused by the formation of polyclonal antibodies against the platelet factor 4-heparin complex. Fatal limb and organ damage or death may occur as a result of this immunological drug reaction. Described in this case report is the management of a patient who developed HIT after undergoing a MitraClip transcatheter mitral valve repair. The aim was to encourage clinicians to pay special attention to a frail patient who receives heparin therapy and to advise clinicians that clinical scores and laboratory tests should be used as a complement for certain diagnosis...
March 2018: Türk Kardiyoloji Derneği Arşivi: Türk Kardiyoloji Derneğinin Yayın Organıdır
https://www.readbyqxmd.com/read/29482938/heparin-resistance-and-intracardiac-thrombosis-may-be-a-harbinger-of-heparin-induced-thrombocytopenia-hit
#19
Jian Ray Zhou, Philip Jones, Lin-Rui Guo, Achal Dhir
No abstract text is available yet for this article.
January 12, 2018: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29470181/prevention-and-management-of-thromboembolism-in-pregnancy-when-heparins-are-not-an-option
#20
Andra H James
Heparins, unfractionated heparin, and low molecular weight heparin, are the preferred anticoagulants in pregnancy. There are circumstances, however, in which an alternative to heparin should be considered. These circumstances include, the presence of heparin resistance, a heparin allergy manifesting as heparin-induced skin reactions or heparin-induced thrombocytopenia, and the presence of a mechanical heart valve. From time to time, the obstetrician is called on to make recommendations about anticoagulants in pregnancy, including in circumstances in which an alternative to heparin has been suggested or is necessary...
February 21, 2018: Clinical Obstetrics and Gynecology
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