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Heparin induced thrombocytopenia

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https://www.readbyqxmd.com/read/29429250/-heparin-induced-thrombocytopenia-should-be-standaridized-for-diagnosis-and-treatment
#1
Y L Han
No abstract text is available yet for this article.
February 6, 2018: Zhonghua Yi Xue za Zhi [Chinese medical journal]
https://www.readbyqxmd.com/read/29426286/monitoring-of-argatroban-and-lepirudin-anticoagulation-in-critically-ill-patients-by-conventional-laboratory-parameters-and-rotational-thromboelastometry-a-prospectively-controlled-randomized-double-blind-clinical-trial
#2
Martin Beiderlinden, Patrick Werner, Astrid Bahlmann, Johann Kemper, Tobias Brezina, Maximilian Schäfer, Klaus Görlinger, Holger Seidel, Peter Kienbaum, Tanja A Treschan
BACKGROUND: Argatroban or lepirudin anticoagulation therapy in patients with heparin induced thrombocytopenia (HIT) or HIT suspect is typically monitored using the activated partial thromboplastin time (aPTT). Although aPTT correlates well with plasma levels of argatroban and lepirudin in healthy volunteers, it might not be the method of choice in critically ill patients. However, in-vivo data is lacking for this patient population. Therefore, we studied in vivo whether ROTEM or global clotting times would provide an alternative for monitoring the anticoagulant intensity effects in critically ill patients...
February 9, 2018: BMC Anesthesiology
https://www.readbyqxmd.com/read/29424412/-treatment-of-heparin-induced-thrombocytopenia-with-rivaroxaban-case-report
#3
Gustavo Rivera O, Oscar Corsi S, Andrés Pavlovic J, Andrés Aizman S, Pablo Varas A
Heparin-induced thrombocytopenia (HIT) is immune-mediated. It occurs more frequently with unfractionated heparin (UFH) than with low molecular weight heparins (LMWH). It is associated with thromboembolic rather than hemorrhagic events, as opposed to thrombocytopenia of other etiologies. The key in therapy is the cessation of heparin and the start of another anticoagulant. We report a 58 years old female with HIT secondary to the use of Enoxaparin who was successfully managed with Rivaroxaban. Our goal is to report a novel therapy and provide the evidence that supports its use...
September 2017: Revista Médica de Chile
https://www.readbyqxmd.com/read/29422736/phlegmasia-cerulea-dolens-following-heparin-induced-thrombocytopenia
#4
Deepesh G Aggarwal, Shilpa S Bhojraj, Ali Asgar Behrainwalla, Charu K Jani, Simin S Mehta
The authors present a case of a 49-year-old woman who underwent coronary artery bypass grafting after suffering from an acute coronary syndrome and later developed phlegmasia cerulea dolens with heparin-induced thrombocytopenia (HIT) and HIT thrombosis (HITT).
January 2018: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/29421832/heparin-induced-thrombocytopenia-during-obstetric-hospital-admissions
#5
Deepika Sagaram, Zainab Siddiq, Andrew B Eisenberger, Cande V Ananth, Jason D Wright, Mary E D'Alton, Alexander M Friedman
INTRODUCTION:  The rate of heparin-induced thrombocytopenia (HIT) on a population basis is unknown. The objective of this study was to characterize the risk for HIT during antepartum, delivery, and postpartum hospitalizations in the United States. MATERIALS AND METHODS: A large administrative database was used to determine the risk of HIT in hospitalized obstetric patients who received unfractionated heparin (UFH) or low molecular weight heparin (LMWH). Patients were presumed to have HIT if they were exposed to UFH or LMWH, received a diagnosis of HIT, and were administered a medication for the treatment of HIT including bivalirudin, argatroban, fondaparinux, or lepirudin...
February 8, 2018: American Journal of Perinatology
https://www.readbyqxmd.com/read/29417080/new-indications-for-dabigatran-a-suggestion-from-a-drug-use-evaluation-study
#6
Farzaneh Ashrafi, Najmeh Rezaie, Sarah Mousavi
Objective: Dabigatran etexilate is a novel oral anticoagulant with several advantages over warfarin such as no need for routine monitoring and fewer drug interactions. This drug was added to our hospital's formulary in 2012. The objective of this study was to assess the rational drug use of dabigatran at a large teaching hospital. Methods: A prospective cross-sectional study was performed from November to June 2015 at Alzahra teaching hospital, Isfahan, Iran. All patients who received at least one dose of dabigatran were eligible for inclusion...
October 2017: Journal of Research in Pharmacy Practice
https://www.readbyqxmd.com/read/29404376/successful-use-of-intravenous-immunoglobulin-g-to-treat-refractory-heparin-induced-thrombocytopenia-with-thrombosis-complicating-peripheral-blood-stem-cell-harvest
#7
Devon S McKenzie, Josephine Anuforo, Jennah Morgan, Elvira Neculiseanu
Heparin-induced thrombocytopenia is a well-known, life-threatening complication that occurs in 5% of patients exposed to heparin. It causes thrombocytopenia in roughly 85% to 90% of affected individuals, with expected recovery in approximately 4 to 10 days following heparin withdrawal. However, there is an entity known as refractory heparin-induced thrombocytopenia with thrombosis in which patients have prolonged thrombocytopenia, refractory to the current standard of care. We present one such case of a 48-year-old male with R-ISS (Revised International Staging System) stage II kappa light chain multiple myeloma in stringent complete response status postinduction therapy...
January 2018: Journal of Investigative Medicine High Impact Case Reports
https://www.readbyqxmd.com/read/29399327/recent-advances-in-understanding-and-management-of-acquired-thrombocytopenia
#8
REVIEW
Srikanth Nagalla, Ravindra Sarode
There are numerous congenital and acquired causes of thrombocytopenia. Thrombocytopenia could be a result of decreased bone marrow production, increased consumption, increased destruction, splenic sequestration or a combination of these causes. In this review, we have focused on some of the serious acquired causes of thrombocytopenia. There have been some significant advances in our understanding of the pathophysiology, diagnostic testing, and treatment of immune thrombocytopenia, heparin-induced thrombocytopenia, thrombotic thrombocytopenic purpura, and atypical hemolytic uremic syndrome over the past five years...
2018: F1000Research
https://www.readbyqxmd.com/read/29395704/personalized-anticoagulation-guided-apixaban-dose-adjustment-to-compensate-for-pharmacokinetic-abnormalities-related-to-short-bowel-syndrome
#9
P Timothy Pollak, Gavin R Sun, Richard B Kim
A 45-year-old woman who required lifelong anticoagulation for recurrent thrombosis had her therapeutic choices limited by heparin-induced thrombocytopenia and abnormal pharmacokinetics (greatly reduced absorption) resulting from short gut syndrome from extensive gut resection after mesenteric thrombosis. As an alternative to inconvenient and expensive injections of fondaparinux, personalized dosing of a direct oral anticoagulant was sought using clinical pharmacology techniques. Enteral absorption was ascertained with small test doses of apixaban, and the ability of supraconventional doses to deliver effective concentrations was verified...
December 27, 2017: Canadian Journal of Cardiology
https://www.readbyqxmd.com/read/29346619/spurious-thrombocytopenia-in-automated-platelet-count
#10
Lixia Zhang, Jian Xu, Li Gao, Shiyang Pan
Spurious thrombocytopenia is a well-known phenomenon observed with the widespread use of hematology analyzers (HAs). In this study, 355 specimens with pseudo-thrombocytopenia (PTCP) were evaluated via epidemiology, identification, remedies, and platelet (PLT) count. Data showed that anticoagulants such as citrate and/or heparin-dependent PTCP (16.0%) became increasingly common, whereas ethylenediaminetetraacetic acid (EDTA)-induced PTCP (49.1%) remained the most frequent. We note that that nearly half of the patients with PTCP had veritable decreased PLT counts, even after PLT levels had been corrected...
January 13, 2018: Laboratory Medicine
https://www.readbyqxmd.com/read/29325985/platelet-activating-antibodies-are-detectable-at-the-earliest-onset-of-heparin-induced-thrombocytopenia-with-implications-for-the-operating-characteristics-of-the-serotonin-release-assay
#11
Theodore E Warkentin, Donald M Arnold, John G Kelton, Jo-Ann I Sheppard, James W Smith, Ishac Nazy
BACKGROUND: HIT is a prothrombotic drug reaction caused by platelet-activating antibodies that recognize PF4/heparin complexes. It is unknown whether platelet-activating antibodies are detectable at the onset of the HIT-related platelet count fall. METHODS: Available blood samples from 18 patients obtained at onset of HIT were tested using the serotonin-release assay (SRA), a test for platelet-activating antibodies, and a PF4-dependent ELISA. Patient samples showing a delay of >2 days between ELISA and SRA seroconversion were tested for subthreshold levels of platelet-activating antibodies using two modifications of the SRA that amplify detection of HIT antibodies...
January 8, 2018: Chest
https://www.readbyqxmd.com/read/29296706/serologic-characterization-of-anti-protamine-heparin-and-anti-pf4-heparin-antibodies
#12
Grace M Lee, Manali Joglekar, Maragatha Kuchibhatla, Sanjay Khandelwal, Rui Qi, Lubica Rauova, Gowthami M Arepally
Anti-protamine (PRT)/heparin antibodies are a newly described class of heparin-dependent antibodies occurring in patients exposed to PRT and heparin during cardiac surgery. To understand the biologic significance of anti-PRT/heparin antibodies, we developed a murine monoclonal antibody (ADA) specific for PRT/heparin complexes and compared it to patient-derived anti-PRT/heparin antibodies, as well as comparing polyclonal and monoclonal antibodies with anti-platelet factor 4 (PF4)/heparin. Using monoclonal antibodies and polyclonal patient-derived antibodies, we show distinctive binding patterns of anti-PRT/heparin antibodies as compared with PF4/heparin antibodies...
April 25, 2017: Blood Advances
https://www.readbyqxmd.com/read/29277148/prostacyclins-in-cardiac-surgery-coming-of-age
#13
Seema P Deshpande, Michael A Mazzeffi, Erik Strauss, Allison Hollis, Kenichi A Tanaka
Prostacyclin (prostaglandin I2 [PGI2]) is an eicosanoid lipid mediator produced by the endothelial cells. It plays pivotal roles in vascular homeostasis by virtue of its potent vasodilatory and antithrombotic effects. Stable pharmacological analogues of PGI2 are used for treatment of pulmonary hypertension and right ventricular failure. PGI2 dose dependently inhibits platelet activation induced by adenosine-5'-diphosphate, arachidonic acid, collagen, and low-dose thrombin. This property has led to its use as an alternative to direct thrombin inhibitors in patients with type II heparin-induced thrombocytopenia (HIT) undergoing cardiac surgery...
December 1, 2017: Seminars in Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29249865/heparin-induced-thrombocytopenia-and-thrombosis-preventing-your-thrombolysis-practice-from-taking-a-hitt
#14
REVIEW
Eric Wannamaker, Kimi Kondo, D Thor Johnson
Heparin-induced thrombocytopenia and thrombosis (HITT) is an under-recognized cause of deep venous thrombosis treatment failure and of complications during catheter-directed thrombolysis. After a review of HITT pathophysiology, diagnosis, and management, three different cases are presented in this article. Each case highlights subtleties and challenges of HITT diagnosis and management. An example of a practical approach to the diagnosis of HITT is presented.
December 2017: Seminars in Interventional Radiology
https://www.readbyqxmd.com/read/29248145/renal-replacement-therapy-and-anticoagulation
#15
REVIEW
Timo Brandenburger, Thomas Dimski, Torsten Slowinski, Detlef Kindgen-Milles
Today, up to 20% of all intensive care unit patients require renal replacement therapy (RRT), and continuous renal replacement therapies (CRRT) are the preferred technique. In CRRT, effective anticoagulation of the extracorporeal circuit is mandatory to prevent clotting of the circuit or filter and to maintain filter performance. At present, a variety of systemic and regional anticoagulation modes for CRRT are available. Worldwide, unfractionated heparin is the most widely used anticoagulant. All systemic techniques are associated with significant adverse effects...
September 2017: Best Practice & Research. Clinical Anaesthesiology
https://www.readbyqxmd.com/read/29238798/association-between-hypercoagulable-conditions-and-calciphylaxis-in-patients-with-renal-disease-a-case-control-study
#16
Allison S Dobry, Lauren N Ko, Jessica St John, J Mark Sloan, Sagar Nigwekar, Daniela Kroshinsky
Importance: Calciphylaxis is a rare skin disease with high morbidity and mortality that frequently affects patients with renal disease. Hypercoagulable conditions are frequently observed in both patients with calciphylaxis and those with chronic kidney disease (CKD), complicating our understanding of which hypercoagulable conditions are specific to calciphylaxis. Objective: To identify hypercoagulable conditions that are risk factors for developing calciphylaxis while controlling for CKD...
December 13, 2017: JAMA Dermatology
https://www.readbyqxmd.com/read/29222319/hits-and-misses-in-100-years-of-heparin
#17
REVIEW
Lawrence Rice
Heparin was discovered 100 years ago, and the heparin-induced thrombocytopenia syndrome was described 40 years ago. That the most powerful anticoagulant of the last century can also produce the most extreme prothrombotic diathesis is but one of the paradoxes that surround heparin-induced thrombocytopenia. Standard treatment is alternative anticoagulation. Advances continue to be made regarding pathophysiology, prevention, and treatment. Currently, an epidemic of overdiagnosis threatens the well-being of patients, so efforts to educate clinicians on when and how to make this diagnosis are pressing...
December 8, 2017: Hematology—the Education Program of the American Society of Hematology
https://www.readbyqxmd.com/read/29199766/pentasaccharides-for-the-treatment-of-deep-vein-thrombosis
#18
REVIEW
Gustavo Ms Brandao, Daniela R Junqueira, Hamilton A Rollo, Marcone L Sobreira
BACKGROUND: Standard treatment of deep vein thrombosis (DVT) is based on antithrombotic therapy, initially with parenteral administration of unfractionated heparin or low molecular weight heparins (LMWH) for five to seven days, then subsequent long-term therapy with oral vitamin K antagonists (e.g. warfarin). Pentasaccharides are novel anticoagulants that may be favourable over standard therapy due to their predictable effect, no need for frequent monitoring or re-dosing, and few known drug interactions...
December 2, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29185142/initial-and-long-term-impact-of-a-multi-disciplinary-task-force-in-the-diagnosis-and-management-of-heparin-induced-thrombocytopenia
#19
Ming Y Lim, Joyce Foster, Angela Rourk, Charles S Greenberg
Many medical centers are faced with a major challenge in making an accurate diagnosis of heparin-induced thrombocytopenia (HIT) and ensuring appropriate changes in management strategy in line with guideline recommendations. We report the initial and long-term impact and challenges of institution-wide changes in the diagnosis and management of HIT in the inpatient setting at an academic medical center. We established a HIT Task Force, consisting of a multidisciplinary team of non-malignant hematologists, nursing, pharmacist, pathology, blood bank and clinical lab informatics...
November 28, 2017: Journal of Thrombosis and Thrombolysis
https://www.readbyqxmd.com/read/29181882/heparin-induced-thrombocytopenia-complicating-children-after-the-fontan-procedure-single-center-experience-and-review-of-the-literature
#20
REVIEW
Uri Pollak, David Mishaly, Gili Kenet, Amir Vardi
Heparin-induced thrombocytopenia (HIT) is a life-threatening complication of heparin therapy. The risk for HIT correlates with the cumulative dosage of heparin exposure. In Fontan patients, recurrent systemic anticoagulation, traditionally with heparin, is used to alleviate the thrombotic complications that may occur postoperatively when the venous pressure rises and the systemic venous flow into the pulmonary arteries becomes sluggish, putting them at increased risk. As a pressure gradient-dependent circulation, elevation in systemic venous pressure, most often by venous thrombosis, contributes to circuit failure...
November 27, 2017: Congenital Heart Disease
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