Heparin Induced Thrombocytopenia (HIT)

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Heparin Induced Thrombocytopenia (HIT): Happening more and more frequently - as we use heparin more and more.
Heparin is produced from the intestines of Pigs and Buffalo

50% reduction in platelets while on Heparin within 5 to 15 days of beginning to use Heparin. If previously used Heparin you can get this in a few hours.
Pathophysiology:
Immune mediated IgG - Ab recognises a complex of Heparin and platelet factor 4 (PF4) leading to platelet activation via platelet Fc receptor and activation of coagulation system - causing thrombocytopenia

SE:
Non-hemorragic side effects

  • Increase in Aminotransferase - this is not liver dysfunction
  • Increase K levels - hyperkalemia
hemorragic side effects
  • thrombosis is detected in 50% of patients:
    • Venous or Arterial
      • 50% decrease in platelets
      • Do an ELISA test to detect the heparin Ab's
      • BLEEDING COMPLICATIONS ARE UNCOMMON
      • Venous thrombosis: DVT and PE
      • Arterial thrombosis: MI, Stroke, limb and mesenteric arteries, adrenal gland involvement
      • Heparin induced skin necrosis
Management
  • Stop all forms of Heparin
  • Sent the ELISA test - for PF4 antibodies
  • Start on a direct thrombin inhibitor - 
    • Argatroban or 
    • Lepirudin (recombinant Hirudin)
    • Danaparoid
  • Follow up for next days - use walferin
  • Make notes in the medical chart - especially over the next 100 days


http://usmlevideooftheday.blogspot.com/2010/05/heparin-induced-thrombocytopenia.html

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