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Heparin-induced Thrombocytopenia

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https://www.readbyqxmd.com/read/29022213/high-prevalence-of-heparin-induced-thrombocytopenia-with-thrombosis-among-patients-with-essential-thrombocytemia-carrying-v617f-mutation
#1
Roberto Castelli, Paolo Gallipoli, Riccardo Schiavon, Thomas Teatini, Giorgio Lambertenghi Deliliers, Luigi Bergamaschini
Arterial and venous complications are major causes of morbidity and mortality in myeloproliferative neoplasms (MPNs). MPNs patients, frequently receive heparin. Heparin-induced thrombocytopenia (HIT) is a rare but potentially life-threatening complication resulting in a severe acquired thrombophilic condition. We carried out a retrospective analysis to evaluate occurrence of new thrombotic events during heparin therapy in essential thrombocythemia (ET) patients. We studied 108 ET patients on heparin for treatment of previous thrombotic events or in thromboprophilaxis...
October 11, 2017: Journal of Thrombosis and Thrombolysis
https://www.readbyqxmd.com/read/28991552/a-platelet-factor-4-dependent-platelet-activation-assay-facilitates-early-detection-of-pathogenic-heparin-induced-thrombocytopenia-antibodies
#2
Curtis G Jones, Shannon M Pechauer, Brian R Curtis, Daniel W Bougie, Mehraboon S Irani, Binod Dhakal, Brenda Pierce, Richard H Aster, Anand Padmanabhan
Heparin-induced thrombocytopenia (HIT) is a dangerous complication of heparin therapy. HIT diagnosis is established by recognizing thrombocytopenia and/or thrombosis in an affected patient and from the results of serological tests such as the platelet factor 4 (PF4)/heparin immunoassay (PF4 ELISA) and serotonin release assay (SRA). Recent studies suggest that HIT antibodies activate platelets by recognizing PF4 in a complex with platelet glycosaminoglycans (and/or polyphosphates) and that an assay based on this principle, the PF4-dependent P-selectin expression assay (PEA), may be even more accurate than the SRA for HIT diagnosis...
October 2017: Chest
https://www.readbyqxmd.com/read/28987395/abciximab-heparin-therapy-for-left-ventricular-assist-device-implantation-in-patients-with-heparin-induced-thrombocytopenia
#3
Chia-Ling Lee, Paolo C Colombo, Andrew Eisenberger, David Diuguid, Douglas L Jennings, Jiho Han, Michael P Salna, Koji Takeda, Paul A Kurlansky, Melana Yuzefpolskaya, Arthur R Garan, Yoshifumi Naka, Hiroo Takayama
BACKGROUND: Optimal anticoagulation strategy remains uncertain in patients with heparin-induced thrombocytopenia (HIT) and undergoing left ventricular assist device (LVAD) implantation. We describe our protocol of abciximab and heparin in these patients. METHODS: Our protocol is to administer abciximab, 0.25 mg/kg loading dose, followed by continuous infusion of 0.125 μg · kg(-1) · min(-1) throughout cardiopulmonary bypass. Full-dose heparin is then given with subsequent additional doses to maintain an activated clotting time of 400 seconds or longer...
October 4, 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/28978299/prevalence-and-overtesting-of-true-heparin-induced-thrombocytopenia-in-a-591-bed-tertiary-care-teaching-hospital
#4
Stephen Farley, Caitlyn Cummings, William Heuser, Shan Wang, Rose Calixte, Adel Hanna, Alexander Axelrad
Heparin-induced thrombocytopenia type II (HIT) is a rare but potentially fatal antibody-mediated reaction to all forms of heparin (unfractionated heparin, low-molecular weight heparin, heparin flushes, and heparin-coated catheters), which can lead to HIT with thrombosis. Two tests commonly used to screen for HIT include the enzyme-linked immunosorbent assay (ELISA) and serotonin release assay (SRA). This is a retrospective chart review study conducted from January 1, 2013, through December 31, 2014, to estimate the rate of true HIT in critical care patients at Winthrop-University Hospital, located in Mineola, New York...
January 1, 2017: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/28970413/fondaparinux-outpatient-use-for-patients-with-a-heparin-induced-thrombocytopenia-history-a-case-report-and-review
#5
Amy Christopher
The purpose of this article is to report a case of fondaparinux outpatient utilization for anticoagulation in a patient with a past medical history of heparin-induced thrombocytopenia (HIT) and discuss the options and need for future anticoagulation research in this unique patient population. A 63-year-old Caucasian female with a previous medical history of HIT thromboprophylaxed with warfarin for a pulmonary embolism presented to an anticoagulation clinic with a subtherapeutic international normalized ratio (INR) after missed warfarin doses...
December 22, 2016: Pharmacy (Basel, Switzerland)
https://www.readbyqxmd.com/read/28968537/pf4-hit-antibody-kko-complexes-activate-broad-innate-immune-and-inflammatory-responses
#6
Lydia A Haile, Roshni Rao, Swamy K Polumuri, Gowthami M Arepally, David A Keire, Daniela Verthelyi, Cynthia D Sommers
INTRODUCTION: Heparin-induced thrombocytopenia (HIT) is an immune-mediated complication of heparin anticoagulation therapy resulting in thrombocytopenia frequently accompanied by thrombosis. Current evidence suggests that HIT is associated with antibodies developed in response to multi-molecular complexes formed by platelet factor 4 (PF4) bound to heparin or cell surface glycosaminoglycans. These antibody complexes activate platelets and monocytes typically through FcγRIIA receptors increasing the production of PF4, inflammatory mediators, tissue factor and thrombin...
September 21, 2017: Thrombosis Research
https://www.readbyqxmd.com/read/28962517/erratum-to-bivalirudin-anticoagulation-for-left-ventricular-assist-device-implantation-on-an-extracorporeal-life-support-system-in-patients-with-heparin-induced-thrombocytopenia-antibodies-%C3%A2-interact-cardiovasc-thorac-surg-2017-1-7-doi-10-1093-icvts-ivx251
#7
Edis Ljajikj, Armin Zittermann, Michiel Morshuis, Jochen Börgermann, Maria Ruiz-Cano, Michael Schoenbrodt, Jan Gummert, Andreas Koster
No abstract text is available yet for this article.
October 1, 2017: Interactive Cardiovascular and Thoracic Surgery
https://www.readbyqxmd.com/read/28958345/intermacs-analysis-of-stroke-during-support-with-continuous-flow-left%C3%A2-ventricular-assist-devices-risk-factors-and-outcomes
#8
Deepak Acharya, Renzo Loyaga-Rendon, Charity J Morgan, Kara A Sands, Salpy V Pamboukian, Indranee Rajapreyar, William L Holman, James K Kirklin, José A Tallaj
OBJECTIVES: This study sought to evaluate predictors of stroke during left ventricular assist device (LVAD) support from data available prior to implantation, and quantify stroke-related morbidity and mortality. BACKGROUND: Stroke is a major complication after LVAD. Pre-implant factors that influence stroke are not well understood. METHODS: We evaluated all patients in INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) who were implanted with continuous flow LVADs from May 1, 2012, to March 31, 2015...
October 2017: JACC. Heart Failure
https://www.readbyqxmd.com/read/28889872/iv-immunoglobulin-for%C3%A2-autoimmune-heparin-induced-thrombocytopenia
#9
EDITORIAL
Shuoyan Ning, Theodore E Warkentin
No abstract text is available yet for this article.
September 2017: Chest
https://www.readbyqxmd.com/read/28884054/the-role-of-apixaban-in-the-treatment-of-heparin-induced-thrombocytopenia
#10
Sidra Khalid, Hamed Daw
Heparin-induced thrombocytopenia (HIT) can present as arterial and venous thrombosis in adults who are treated with heparin. We present a case of a patient who developed HIT when she was treated for deep venous thrombosis (DVT) and pulmonary embolism with heparin. During the treatment with heparin and while being transitioned to warfarin, she developed arterial thrombosis. A work-up for HIT was sent, and it was positive. She was started on the argatroban drip and her platelet counts stabilized. Since her platelet counts remained stable and were not increasing for three weeks, we decided to transition the patient to an oral anticoagulant...
July 5, 2017: Curēus
https://www.readbyqxmd.com/read/28864160/incidence-and-outcomes-of-heparin-induced-thrombocytopenia-in-patients-undergoing-vascular-surgery
#11
Rabail Chaudhry, Robert Wegner, John F Zaki, Greesha Pednekar, Alex Tse, Naveen Kukreja, Navneet Grewal, George W Williams
OBJECTIVE: The National Inpatient Sample (NIS) from years 2010 through 2012 was utilized to determine the incidence, predictive risk factors, and outcomes of heparin-induced thrombocytopenia (HIT) in patients undergoing vascular surgery. DESIGN: Retrospective population-based study. SETTING: Data from the National Inpatient Sample (NIS) (2011 through 2013) using specific International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) procedure codes corresponding with vascular surgery...
October 2017: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/28856946/spontaneous-hit-syndrome-post-knee-replacement-surgery-with-delayed-recovery-of-thrombocytopenia-a-case-report-and-literature-review
#12
Dilli Ram Poudel, Sushil Ghimire, Rashmi Dhital, Daniel A Forman, Theodore E Warkentin
Recently published reports have established a heparin-induced thrombocytopenia (HIT)-mimicking thromboembolic disorder without proximate heparin exposure, called spontaneous HIT syndrome. Although the pathophysiology remains unclear, anti-platelet factor 4 (PF4)/heparin antibodies possibly triggered by exposure to knee cartilage glycosaminoglycans or other non-heparin polyanions found on bacterial surfaces and nucleic acids have been postulated. We present a 53-year-old female receiving antithrombotic prophylaxis with aspirin following right total knee replacement surgery (without perioperative or any previous lifetime heparin exposure) who acutely presented with high-risk pulmonary embolism (PE) and right great saphenous vein thrombophlebitis on postoperative day (POD) 14; her platelet count at presentation was 13 × 10(9)/L...
September 2017: Platelets
https://www.readbyqxmd.com/read/28846826/autoimmune-heparin-induced-thrombocytopenia
#13
REVIEW
A Greinacher, Kathleen Selleng, T E Warkentin
Autoimmune heparin-induced thrombocytopenia (aHIT) indicates patients with anti-PF4/polyanion antibodies that are able to activate platelets strongly even in the absence of heparin (heparin-independent platelet activation). Nevertheless, as seen with serum obtained from patients with otherwise typical HIT, serum-induced platelet activation is inhibited at high heparin concentrations (10-100 IU/mL heparin). Further, upon serial dilution, aHIT serum will usually exhibit heparin-dependent platelet activation. Clinical syndromes associated with aHIT include: delayed-onset HIT, persisting HIT, spontaneous HIT, fondaparinux-associated HIT, heparin "flush"-induced HIT, and severe HIT (platelet count <20×10(9) /L) with associated disseminated intravascular coagulation (DIC)...
August 28, 2017: Journal of Thrombosis and Haemostasis: JTH
https://www.readbyqxmd.com/read/28843825/implementation-of-a-rapid-hit-immunoassay-at-a-university-hospital-retrospective-analysis-of-hit-laboratory-orders-in-patients-with-thrombocytopenia
#14
Anne Black, Susanne Heimerl, Linnéa Oertli, Wolf Wilczek, Andreas Greinacher, Michael Spannagl, Wolfgang Herr, Christina Hart
BACKGROUND: Heparin-induced thrombocytopenia (HIT) is a rare cause of thrombocytopenia and a potentially life-threatening adverse drug reaction. Clinical overdiagnosis of HIT results in costly laboratory tests and anticoagulation. Criteria and algorithms for diagnosis are established, but their translation into clinical practice is still challenging. STUDY DESIGN AND METHODS: In a retrospective approach we studied all HIT related laboratory test requests within four years and evaluated data before (1st period, 24month) and after (2nd period, 24month) replacing particle gel immunoassay (PaGIA) and enzyme-linked immunosorbent assay (ELISA) by a chemiluminescent immunoassay (CLIA)...
August 15, 2017: Thrombosis Research
https://www.readbyqxmd.com/read/28839178/hypercoagulability-progresses-to-hypocoagulability-during-evolution-of-acetaminophen-induced-acute-liver-injury-in-pigs
#15
Karla Chui Luan Lee, Luisa Baker, Susan Mallett, Anne Riddell, Pratima Chowdary, Hatim Alibhai, Yu-Mei Chang, Simon Priestnall, Giacomo Stanzani, Nathan Davies, Rajeshwar Mookerjee, Rajiv Jalan, Banwari Agarwal
Increases in prothrombin time (PT) and international normalised ratio (INR) characterise acute liver injury (ALI) and failure (ALF), yet a wide heterogeneity in clotting abnormalities exists. This study defines evolution of coagulopathy in 10 pigs with acetaminophen (APAP)-induced ALI compared to 3 Controls. APAP administration began at 0 h and continued to 'ALF', defined as INR >3. In APAP pigs, INR was 1.05 ± 0.02 at 0 h, 2.15 ± 0.43 at 16 h and > 3 at 18 ± 1 h. At 12 h thromboelastography (TEG) demonstrated increased clot formation rate, associated with portal vein platelet aggregates and reductions in protein C, protein S, antithrombin and A Disintegrin and Metalloprotease with Thrombospondin type 1 repeats-13 (ADAMTS-13) to 60%, 24%, 47% and 32% normal respectively...
August 24, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28837208/platelet-count-recovery-and-seroreversion-in-immune-hit-despite-continuation-of-heparin-further-observations-and-literature-review
#16
Andrew W Shih, Jo-Ann I Sheppard, Theodore E Warkentin
One of the standard distinctions between type 1 (non-immune) and type 2 (immune-mediated) heparin-induced thrombocytopenia (HIT) is the transience of thrombocytopenia: type 1 HIT is viewed as early-onset and transient thrombocytopenia, with platelet count recovery despite continuing heparin administration. In contrast, type 2 HIT is viewed as later-onset (i. e., 5 days or later) thrombocytopenia in which it is generally believed that platelet count recovery will not occur unless heparin is discontinued. However, older reports of type 2 HIT sometimes did include the unexpected observation that platelet counts could recover despite continued heparin administration, although without information provided regarding changes in HIT antibody levels in association with platelet count recovery...
October 5, 2017: Thrombosis and Haemostasis
https://www.readbyqxmd.com/read/28830286/anticoagulation-of-percutaneous-ventricular-assist-device-using-argatroban-based-purge-solution-a-case-series
#17
Emily C Blum, Carolyn R Martz, Yelena Selektor, Hassan Nemeh, Zachary R Smith, Long To
Impella devices are percutaneously inserted ventricular assist devices which require a continuous purge solution that contains heparin to prevent pump thrombosis and device failure. We describe 2 patients with heparin-induced thrombocytopenia (HIT) supported with an Impella device utilizing an argatroban-based purge solution. Case 1 involved an 83-year-old female with biventricular failure which resulted in right ventricle Impella support. The purge solution was changed to include argatroban due to concern of device clotting in the setting of HIT...
January 1, 2017: Journal of Pharmacy Practice
https://www.readbyqxmd.com/read/28808492/assessment-of-anti-factor-xa-activity-of-enoxaparin-for-venous-thromboembolism-prophylaxis-in-morbidly-obese-surgical-patients
#18
Nouf Al Otaib, Zohour Bootah, Maha A Al Ammari, Tariq M Aldebasi, Abdulmalik M Alkatheri, Shmeylan A Al Harbi, Salah M AbuRuz, Abdulkareem M AlBekairy
BACKGROUND: Venous thromboembolism (VTE) can be encountered by 60% of hospitalized patients. Anticoagulants have been recommended to reduce the risk of VTE in patients with risk factors. However, no specific dosing recommendations for obese patients are provided in the current practice guidelines. The purpose of this study was to determine the efficacy and safety of weight-based dosing of enoxaparin for VTE prophylaxis among morbidly obese patients undergoing surgery. METHODS: Adult patients were enrolled if they have a body mass index (BMI) of ≥35 kg/m(2) and were scheduled for surgery...
July 2017: Annals of Thoracic Medicine
https://www.readbyqxmd.com/read/28807578/heparin-induced-thrombocytopenia-and-vascular-surgery
#19
EDITORIAL
Martin W Besser, Alain Vuylsteke
No abstract text is available yet for this article.
October 2017: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/28804833/laboratory-testing-protocols-for-heparin-induced-thrombocytopenia-hit-testing
#20
Kun Kan Edwin Lau, Soma Mohammed, Leonardo Pasalic, Emmanuel J Favaloro
Heparin-induced thrombocytopenia (HIT) represents a significant high morbidity complication of heparin therapy. The clinicopathological diagnosis of HIT remains challenging for many reasons; thus, laboratory testing represents an important component of an accurate diagnosis. Although there are many assays available to assess HIT, these essentially fall into two categories-(a) immunological assays, and (b) functional assays. The current chapter presents protocols for several HIT assays, being those that are most commonly performed in laboratory practice and have the widest geographic distribution...
2017: Methods in Molecular Biology
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