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Heparin induced thrombocytopenia

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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
#1
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
#2
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
#3
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 asses 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
#4
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
#5
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
#6
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
#7
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
#8
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
#9
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
#10
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
#11
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
#12
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
#13
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
#14
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 1200 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 the dilute Russell viper venom test (DRVVT)...
December 12, 2016: Antimicrobial Agents and Chemotherapy
https://www.readbyqxmd.com/read/27943368/rapid-and-durable-response-to-intravenous-immunoglobulin-in-delayed-heparin-induced-thrombocytopenia-a-case-report
#15
Brandon Z Lei, Joseph J Shatzel, Merav Sendowski
BACKGROUND: Heparin-induced thrombocytopenia (HIT) results in platelet consumption and a virulent thrombotic state, which generally responds to cessation of heparin and initiation of anticoagulation. Rarely, delayed HIT can occur and/or persist after heparin is discontinued. STUDY DESIGN AND METHODS: A 47-year-old male developed delayed HIT with severe thrombocytopenia and thrombosis after cardiac surgery. Thrombocytopenia developed and persisted after heparin cessation and did not improve despite sequential use of argatroban followed by bivalirudin...
December 9, 2016: Transfusion
https://www.readbyqxmd.com/read/27943026/evaluating-the-safety-and-effectiveness-of-venous-thromboembolism-prophylaxis-in-patients-with-sickle-cell-disease
#16
Denise Kelley, Lauren Thornton Jones, Jun Wu, Nicole Bohm
Nearly every component of hemostasis is altered in sickle cell disease (SCD), yet little evidence exists to guide utilization of venous thromboembolism prophylaxis (VTEP) in this population. This retrospective cohort study included 135 adult patients admitted with a diagnosis of SCD vaso-occlusive crisis to the general medicine service at a tertiary care academic medical center from August 1, 2011 to August 1, 2013. If VTEP was discontinued, the medical record was reviewed for suspicion of VTE, hemorrhage, heparin-induced thrombocytopenia (HIT), or other adverse events...
December 10, 2016: Journal of Thrombosis and Thrombolysis
https://www.readbyqxmd.com/read/27913490/heparin-induced-thrombocytopenia-research-and-clinical-updates
#17
Oluwatoyosi Onwuemene, Gowthami M Arepally
Heparin-induced thrombocytopenia (HIT) remains an important diagnosis to consider in hospitalized patients developing thrombocytopenia. HIT is an immune-mediated prothrombotic disorder caused by antibodies to platelet factor 4 (PF4) and heparin. Recent basic scientific studies have advanced our understanding of disease pathogenesis through studies of the PF4/heparin structure, immune mechanisms, and cellular basis of thrombosis. Clinical advances have also occurred in areas of HIT prevention, description of disease variants, and diagnostic strategies...
December 2, 2016: Hematology—the Education Program of the American Society of Hematology
https://www.readbyqxmd.com/read/27878507/the-scope-and-value-of-an-anticoagulation-stewardship-program-at-a-community-teaching-hospital
#18
Maura K Wychowski, Christina I Ruscio, Peter A Kouides, Ronald L Sham
To report the impact of an inpatient anticoagulation stewardship program at a community hospital to promote optimal anticoagulant use. The anticoagulation team (ACT) stewardship program consists of two clinical pharmacists and hematologists to provide oversight of anticoagulants, high cost reversal agents including prothrombin complex concentrate (PCC, Kcentra™), and heparin-induced thrombocytopenia (HIT) management. Intervention data and number of charts reviewed were collected. Average cost avoidance data was applied to ACT interventions to estimate cost savings...
November 22, 2016: Journal of Thrombosis and Thrombolysis
https://www.readbyqxmd.com/read/27864862/heparin-induced-multi-electrode-aggregometry-method-for-heparin-induced-thrombocytopenia-testing-communication-from-the-ssc-of-the-isth
#19
M-C Morel-Kopp, F Mullier, V Gkalea, T Bakchoul, V Minet, I Elalamy, C M Ward
No abstract text is available yet for this article.
December 2016: Journal of Thrombosis and Haemostasis: JTH
https://www.readbyqxmd.com/read/27850923/1287-defining-heparin-induced-thrombocytopenia-management-failure-in-the-icu
#20
Erin Mancl, Allyson Wexler, Srinath Sriram, Sean Forsythe
No abstract text is available yet for this article.
December 2016: Critical Care Medicine
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