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Heparin-induced Thrombocytopenia

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https://www.readbyqxmd.com/read/28331172/an-anti-coagulation-conundrum-implantation-of-total-artificial-heart-in-a-patient-with-heparin-induced-thrombocytopenia-type-ii
#1
Theodore J Cios, Yuliana Salamanca-Padilla, Dmitri Guvakov
BACKGROUND Heparin-induced thrombocytopenia (HIT) is a rare but life-threatening complication of heparin administration. It can present a major clinical dilemma for physicians caring for patients requiring life-saving urgent or emergent cardiac surgery. Studies have been published examining the use of alternative anticoagulants for patients undergoing cardiopulmonary bypass (CPB), however, evidence does not clearly support any particular approach. Presently, there are no large-scale, prospective randomized studies examining the impact of alternative anticoagulants on clinical outcomes for HIT-positive patients requiring cardiac surgery...
March 23, 2017: American Journal of Case Reports
https://www.readbyqxmd.com/read/28321711/heparin-induced-thrombocytopenia-with-mechanical-circulatory-support-devices-review-of-the-literature-and-management-considerations
#2
REVIEW
Jonathan Bain, Alexander H Flannery, Jeremy Flynn, William Dager
Whether for temporary or long term use, mechanical circulatory support (MCS) has seen increased utilization and interest over the past several years. Even though these devices innately cause thrombocytopenia, co-administration of heparin anticoagulation carries the risk for heparin-induced thrombocytopenia (HIT). This poses challenges for practitioners as very few studies provide guidance for the management of this condition, particularly in this population. This has led to a wide spectrum of treatment protocols within current practice...
March 20, 2017: Journal of Thrombosis and Thrombolysis
https://www.readbyqxmd.com/read/28320219/monitoring-of-argatroban-and-lepirudin
#3
Holger Seidel, Hans-Jürgen Kolde
Monitoring of direct thrombin inhibitors (DTIs) in patients with heparin-induced thrombocytopenia (HIT) is primarily performed using the activated partial thromboplastin time (aPTT). This assay is poorly standardized, reagent dependent, and not DTI specific. We compared aPTT, thrombin time (TT), and prothrombin time (PT) to drug levels obtained by the ecarin chromogenic assay (ECA). We analyzed 495 samples of patients with confirmed or suspected HIT on treatment with either argatroban (n = 37) or lepirudin (n = 80)...
January 1, 2017: Clinical and Applied Thrombosis/hemostasis
https://www.readbyqxmd.com/read/28314810/unusual-case-of-venous-thrombosis
#4
Oliver Jones, Richard Gooding
A young woman developed a line-associated deep vein thrombosis (DVT), which was treated with low molecular weight heparin (dalteparin). 8 days later, the DVT had significantly extended-in spite of therapeutic heparin levels. A diagnosis of heparin-induced thrombocytopenia and thrombosis (HITT) was considered, but the platelet count had not dropped. Nevertheless, a HITT assay was carried out which came back positive, with a repeat assay confirming the result. Dalteparin was stopped and apixaban treatment started, with symptomatic recovery over the following days and weeks...
March 17, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28302464/coronary-artery-perforation-complicated-by-recurrent-cardiac-tamponade-a-case-illustration-and-review
#5
Michael DePersis, Safi U Khan, Edo Kaluski, William Lombardi
Coronary artery perforation during percutaneous intervention is a rare but potentially life threatening complication. The treatment of coronary perforation can be challenging in view of potential life threatening consequences such as cardiac tamponade or myocardial infarction. Presented is a clinical course of a 69year-old female who developed cardiac tamponade as a result of presumed wire related perforation of the posterolateral branch of the right coronary artery. Her clinical course was further complicated by recurrent tamponade, atrial fibrillation, stress induced cardiomyopathy, heparin induced thrombocytopenia and cardiogenic pulmonary edema...
March 7, 2017: Cardiovascular Revascularization Medicine: Including Molecular Interventions
https://www.readbyqxmd.com/read/28301915/emerging-role-of-direct-oral-anticoagulants-in-the-management-of-heparin-induced-thrombocytopenia
#6
Phu Ngoc Tran, Minh-Ha Tran
Heparin-induced thrombocytopenia (HIT) and heparin-induced thrombocytopenia with thrombosis (HITT) are rare but potentially limb- and life-threatening complications of heparin therapy. Continuation of heparin or low-molecular-weight heparin is contraindicated due to platelet activation in the presence of (heparin-dependent) HIT antibodies. Primary treatment options currently include argatroban, fondaparinux, or bivalirudin. However, the parenteral administration routes and interference of argatroban with traditional coagulation markers complicate management...
January 1, 2017: Clinical and Applied Thrombosis/hemostasis
https://www.readbyqxmd.com/read/28298667/suspected-heparin-induced-thrombocytopenia-in-patients-receiving-extracorporeal-membrane-oxygenation
#7
Bhupinder Natt, Cameron Hypes, Robyn Basken, Joshua Malo, Toshinobu Kazui, Jarrod Mosier
Heparin-induced thrombocytopenia (HIT) is an immune reaction usually secondary to unfractionated heparin. Anticoagulation management is critical in patients while on extracorporeal membrane oxygenation (ECMO) to prevent thromboembolism and for the optimal functioning of the circuit. We identified five patients with respiratory failure at our hospital managed with ECMO in the last 2 years that were treated for HIT. A brief clinical course and their management are discussed. We also briefly review the literature for best evidence for management of such patients...
March 2017: Journal of Extra-corporeal Technology
https://www.readbyqxmd.com/read/28294347/nadroparin-carries-a-potentially-high-risk-of-inducing-cutaneous-delayed-type-hypersensitivity-responses
#8
Marc Schindewolf, Andreas Recke, Detlef Zillikens, Edelgard Lindhoff-Last, Ralf J Ludwig
BACKGROUND: Heparins are widely used for the prophylaxis/treatment of thromboembolic events. As adverse effects, heparin-induced skin lesions occur frequently (in 7.5-39% of patients). Skin lesions may be the only clinical manifestation of life-threatening immune-mediated heparin-induced thrombocytopenia, but are commonly caused by a delayed-type hypersensitivity response [heparin-induced delayed-type hypersensitivity (HIHS)]. Risk factors have not been prospectively identified. OBJECTIVES: To identify possible risk factors for heparin-induced skin lesions from three independent clinical trials in a combined analysis...
March 14, 2017: Contact Dermatitis
https://www.readbyqxmd.com/read/28289828/is-low-serum-albumin-level-a-significant-predictor-for-the-development-of-heparin-induced-thrombocytopenia-thrombosis
#9
Fahad A S Al-Eidan, J A Al-Gramish, H A Al-Zamil, M A Crowther
The present study investigates the effect of albumin levels in patients who have developed heparin-induced thrombocytopenia (HIT) and heparin-induced thrombocytopenia-thrombosis (HITT). A retrospective observational cohort study was conducted at King Abudlaziz Medical City (KAMC), a university teaching hospital, on patients diagnosed with HIT between June 2013 and December 2014. Clinical and laboratory findings were used to confirm HIT. Albumin levels were reported on admission as baseline and during HIT occurrence...
March 13, 2017: Annals of Hematology
https://www.readbyqxmd.com/read/28287032/new-platelet-functional-method-for-identification-of-pathogenic-antibodies-in-hit-patients
#10
M L Guarino, I Massimi, S Mardente, A Lappa, S Donfrancesco, G P Visentin, F M Pulcinelli
Heparin-induced thrombocytopenia (HIT) is a thrombotic complication of heparin therapy. The most used functional method for HIT diagnosis is serotonin release assay (SRA). A different functional method based on ATP release with luciferin/luciferase long-life and stable luminescent signal is used here, which is shown to be comparable for accuracy with SRA in both negative (patients 4Ts ≤3, and negative for both anti-PF4/heparin immunoassay and SRA) and positive (4Ts >3, and positive for both PF4/heparin antibodies and SRA) patients...
March 13, 2017: Platelets
https://www.readbyqxmd.com/read/28283268/perioperative-management-of-vitamin-k-antagonists-in-patients-with-low-thromboembolic-risk-undergoing-elective-surgery-a-prospective-experience
#11
Ana Florencia Becerra, María Teresita Cornavaca, José Ignacio Revigliono, Alejandro Contreras, Ricardo Albertini, Aldo Hugo Tabares
BACKGROUND AND OBJECTIVES: To quantify thromboembolic and bleeding events in patients with low thromboembolic risk, who were chronically receiving vitamin K antagonists and undergoing elective surgery. MATERIAL AND METHODS: A descriptive, prospective, single-center study was conducted between December 2010 and July 2014. Patients aged over 18 years old, chronically anticoagulated with vitamin K antagonists and admitted for elective surgery were included in the study...
March 7, 2017: Medicina Clínica
https://www.readbyqxmd.com/read/28271738/profile-of-instrumentation-laboratory-s-hemosil%C3%A2-acustar-hit-ab-pf4-h-assay-for-diagnosis-of-heparin-induced-thrombocytopenia
#12
Michael Nagler, Adam C Cuker
Immunoassays play an essential role in the diagnosis of heparin-induced thrombocytopenia (HIT). The objective of this article is to review HemosIL® AcuStar HIT-Ab(PF4-H) (Instrumentation Laboratory, Bedford, MA, USA), a new chemiluminescent immunoassay for HIT. Areas covered: The authors searched the published literature for evaluation studies of HemosIL® AcuStar HIT-Ab(PF4-H) and sought information from the manufacturer. In this paper, the authors discuss the analytical principle and technical aspects of the assay; describe its diagnostic performance in validation studies; report on its reproducibility, cost-effectiveness, and regulatory status; and discuss the implications of the assay on clinical practice and means of integrating it in diagnostic pathways...
March 8, 2017: Expert Review of Molecular Diagnostics
https://www.readbyqxmd.com/read/28262567/evaluation-of-a-diagnostic-algorithm-for-heparin-induced-thrombocytopenia
#13
Maria Farm, Tamam Bakchoul, Tony Frisk, Karina Althaus, Alice Odenrick, Eva-Marie Norberg, Maria Berndtsson, Jovan P Antovic
INTRODUCTION: Heparin-Induced Thrombocytopenia (HIT) is a rare but serious immune-mediated complication of heparin treatment. HIT is characterized by an acute, transient prothrombotic state combined with thrombocytopenia and is caused by platelet-activating IgG antibodies that bind to complexes of heparin and platelet factor 4. The diagnosis of HIT relies on clinical presentation and the demonstration of HIT antibodies. One approach to improve the efficacy of laboratory analysis is to use a diagnostic algorithm...
February 24, 2017: Thrombosis Research
https://www.readbyqxmd.com/read/28261509/spontaneous-heparin-induced-thrombocytopenia-and-venous-thromboembolism-following-total-knee-arthroplasty
#14
Kevin Baker, Ming Y Lim
A 72-year-old Caucasian woman was admitted for an elective left total knee arthroplasty. Her surgery was uncomplicated and she was discharged to a rehabilitation facility. Twelve days later, she developed acute shortness of breath followed by a syncopal episode. She was hypoxic and cyanotic, requiring hospitalization and intubation, and was subsequently diagnosed with bilateral submassive pulmonary emboli and bilateral lower extremity deep vein thrombosis. She was started on unfractionated heparin infusion...
2017: Case Reports in Hematology
https://www.readbyqxmd.com/read/28248809/heparin-induced-thrombocytopenia
#15
Cynthia A Frazer
Heparin-induced thrombocytopenia (HIT) is an immune-mediated complication of heparin therapy. The use of heparin to flush some vascular access devices makes HIT a concern for infusion nurses. This article reviews the risk factors for, pathophysiology of, and management of HIT.
March 2017: Journal of Infusion Nursing: the Official Publication of the Infusion Nurses Society
https://www.readbyqxmd.com/read/28243155/perioperative-care-in-an-adolescent-patient-with-heparin-induced-thrombocytopenia-for-placement-of-a-cardiac-assist-device-and-heart-transplantation-case-report-and-literature-review
#16
Mineto Kamata, Roby Sebastian, Patrick I McConnell, Daniel Gomez, Aymen Naguib, Joseph D Tobias
Heparin-induced thrombocytopenia (HIT) can cause life-threatening complications following the administration of heparin. Discontinuation of all sources of heparin exposure and the use of alternative agents for anticoagulation are necessary when HIT is suspected or diagnosed. We present the successful use of bivalirudin anticoagulation in an adolescent patient during cardiopulmonary bypass who underwent both placement of a left ventricular assist device and subsequent heart transplantation within a 36-hour period...
2017: International Medical Case Reports Journal
https://www.readbyqxmd.com/read/28218620/endothelial-antigen-assembly-leads-to-thrombotic-complications-in-heparin-induced-thrombocytopenia
#17
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...
March 1, 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
#18
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
#19
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
#20
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
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