We describe a 58yearold nulliparous obese woman who developed severe. Heparininduced thrombocytopenia history and exam bmj. Heparininduced thrombocytopenia in a patient treated with. Overlap warfarin therapy with direct thrombin inhibitor dti continuous infusion for at least 5 days. Heparininduced thrombocytopenia hit is a complication of heparin therapy and is characterized by two types. Heparin induced thrombocytopenia hit is an immunemediated hypercoagulable disorder caused by antibodies to platelet factor 4 pf4 and heparin. Similar to itp, heparininduced thrombocytopenia hit is an. The identification and management of heparininduced. New guidelines for heparininduced thrombocytopenia. This algorithm has been developed for md anderson using a multidisciplinary approach considering circumstances particular to md andersons specific patient population, services and structure, and clinical information. This clinical practice guideline is intended to provide recommendations for the diagnosis and treatment of hit. Treatment involves prompt cessation of heparin and treatment with argatroban or offlabel fondaparinux. Heparininduced thrombocytopenia is a profoundly dangerous, potentially lethal, immunologically mediated adverse drug reaction to unfractionated heparin or, less commonly, to lowmolecular weight heparin. The propensity for thrombosis distinguishes hit from other common drug induced.
The search covered articles published from january 2006 to april 2012. Uw health moderate quality of evidence, strong recommendation 2. The following guideline is intended to guide the management of heparin induced thrombocytopenia and includes recommendations for diagnosis and treatment agents. Ip hit heparin induced thrombocytopenia adult supplemental order set 3596. Mar 22, 2011 heparin, a negatively charged glycosaminoglycan 3,00030,000 da, is an anticoagulant released by mast cells and basophils during the normal clotting process. List of heparininduced thrombocytopenia medications.
Apixaban for treatment of confirmed heparininduced. Enoxaparin dose reduction for thrombocytopenia in patients. Salter bs, weiner mm, trinh ma, heller j, evans as, adams dh, et al. Diagnosis of hit is based on both clinical thrombocytopenia or new thrombosis and laboratory findings. Antithrombotic therapy and prevention of thrombosis, 9th ed. Jan 23, 2012 thrombocytopenia defined as a platelet count 150. When drugs or medications are the causes of a low platelet count, it is called drug induced thrombocytope. Thrombocytopenia defined as a platelet count hit treatment page 2 of 7 disclaimer. Heparin induced thrombocytopenia hit is a lifethreatening complication of exposure to heparin ie, unfractionated heparin, low molecular weight lmw heparin that occurs in up to 5 percent of patients exposed, regardless of the dose, schedule, or route of administration. Key clinical pointsheparininduced thrombocytopenia heparininduced thrombocytopenia hit is characterized by a decrease in the platelet count of more than 50% from the highest platelet count valu.
However, the mean platelet counts per cancer associated thrombocytopenia episode varied significantly across management categories heparin induced thrombocytopenia and includes recommendations for diagnosis and treatment agents. American college of chest physicians evidencebased clinical practice guidelines 8th edition chest. The pathogenesis of venous limb gangrene associated with heparin induced thrombocytopenia. New guidelines for heparin induced thrombocytopenia on september 3, 20 uwmedicine laboratory services released a new reflexive panel for hit antibody testing. An overview of the heparin induced thrombocytopenia syndrome. A search was performed of pubmed and embase using the term heparin induced thrombocytopenia combined with diagnosis, treatment and clinical presentation. Heparin induced thrombocytopenia hit treatment page 1 of 7.
However, the mean platelet counts per cancer associated thrombocytopenia episode varied significantly across management categories heparin induced thrombocytopenia who require anticoagulant therapy kathryn hassell, md for patients with heparin induced thrombocytopenia hit, reexposure to heparin is generally not recommended. Heparin induced thrombocytopenia hit is a rare, transient, acquired procoagulant syndrome. Heparin is widely used for thromboprophylaxis or treatment in many clinical situations, including cardiovascular and orthopaedic surgery and invasive procedures, acute coronary syndromes, venous thromboembolism, atrial fibrillation, peripheral occlusive disease, dialysis, and during extracorporeal circulation. Treatment and prevention of heparin induced thrombocytopenia. Heparin induced thrombocytopenia and thrombosis syndrome hitts is associated with severe thrombocytopenia and paradoxically thrombotic episodes instead of hemorrhagic complications. Heparininduced thrombocytopenia hit is a drugmediated, prothrombotic. The recommended maximum initial dose of warfarin is 5 mg.
Hit results from an autoantibody directed against platelet factor 4. Heparininduced thrombocytopenia hit is a condition that causes a decrease of platelets in the blood. This is the case of a patient with heparin induced thrombocytopenia hit, a syndrome that can be potentially fatal. Heparininduced thrombocytopenia what you need to know. The result is venous and occasionally arterial thrombosis. A severe drug reaction to heparin that can lead to life and limbthreatening venous andor arterial thromboembolism. Heparininduced thrombocytopenia genetic and rare diseases. Physicians advanced practice providers registered nurses pharmacists cpg objectives. Persistent heparininduced thrombocytopenia treated with.
Nonheparin anticoagulants for heparininduced thrombocytopenia. Heparin induced thrombocytopenia hit treatment md anderson. Jul 14, 2017 heparininduced thrombocytopenia hit results in high rate of thrombosis 50% and mortality 1030% if untreated 1, 2. Antiplateletantibodies are not thought to be sufficiently sensitive or specific to rule in or out itp. Two points if necrotizing heparininduced skin lesions even if thrombocytopenia not present. An iv or central line that is flushed with heparin or coated with heparin. Target population adult patients with suspicion or diagnosis of heparin induced thrombocytopenia key practice recommendations screening for hit 1.
Occurs in patients receiving heparin for more than 5 days. While the condition carries a high risk for morbidity and mortality, early detection and prompt treatment can greatly reduce the associated risk to life and limb. A greenfield filter was placed, and treatment doses of enoxaparin were resumed. Rarely, patients with hitprovoked deep vein thrombosis dvt will present with venous limb gangrene as a consequence of inappropriate treatment with a vitamin k antagonist. The pathophysiology of heparin induced thrombocytopenia includes an immunemediated reaction to heparin that activates platelets and results in an acquired hypercoagulability. Diagnosis requires the combination of a compatible clinical picture and laboratory confirmation of the presence of heparin dependent plateletactivating hit antibodies. Sep 18, 2006 following the recent publication of the british committee for standards in haematology bcsh guidelines on the management of heparin. American college of chest physicians evidencebased clinical practice guidelines. The second tutorial will discuss the treatment options for hit and alternative anticoagulant therapy. Although hit is considered to be a rare complication of heparin treatment, the very. Heparininduced thrombocytopenia heparininduced thrombocytopenia hit is characterized by a decrease in the platelet count of more than 50% from the highest platelet count value after the start of heparin, an onset 5 to 10 days after the start of heparin, hypercoagulability, and the presence of heparindependent, plateletactivating igg. The guide goes into extensive detail on exactly what you need to do to safely, effectively and permanently get rid of gout, and you are guaranteed to see dramatic improvements in days if not hours.
The role of a bone marrow biopsy is to rule out other causes of thrombocytopenia or an underlying lymphoproliferative disorder. Heparin induced thrombocytopenia hit intended users. May 03, 2012 heparin induced thrombocytopenia hit is an adverse reaction to the drug heparin resulting in an abnormally low amount of platelets thrombocytopenia. The guide goes into extensive detail on exactly what you need to do to. Feb 03, 2020 heparin induced thrombocytopenia hit is a condition that causes a decrease of platelets in the blood. Heparin induced thrombocytopenia hit treatment page 2 of 7 disclaimer. Heparin induced thrombocytopenia adult inpatient clinical. Current guidelines recommend cessation of heparin for patients strongly suspected of having hit and prompt initiation of a nonheparin direct thrombin inhibitor for anticoagulation, such as argatroban or bivalirudin. Key clinical pointsheparin induced thrombocytopenia heparin induced thrombocytopenia hit is characterized by a decrease in the platelet count of more than 50% from the highest platelet count valu. Heparin induced thrombocytopenia is a clinicopathologic syndrome that can be associated with severe complications and significant mortality.
Dec 12, 2019 delayedonset heparin induced thrombocytopenia and thrombosis. Heparin induced thrombocytopenia is a transient development of antibodies to heparin. In contrast, antipf4heparin antibodies form in only about 10% of patients who undergo orthopedic surgery, but heparininduced thrombocytopenia develops in half those patients. Heparininduced thrombocytopenia hit is a lifethreatening immune response to heparin and its derivatives that is associated with a high risk of thromboembolic complications. This is the fourth article in the series, heparin induced thrombocytopenia. Hit usually occurs after you are treated with heparin. Treatment must be tailored to the individual patient and scenario. Its diagnosis is based on a medical condition compatible with this syndrome and. Sep 08, 2010 the end of gout is a short, to the point guide on how to reverse gout symptoms without ever leaving your home. Treatment and prevention of heparininduced thrombocytopenia. Eight of the 9 patients with heparin induced thrombocytopenia also had one or more thrombotic events venous in 7 and arterial in 1, as compared with 117 of 656 patients without heparin induced. Guidelines on the diagnosis and management of heparin. Heparin induced thrombocytopenia hit is a prothrombotic state associated with antiplatelet factor 4 pf4 heparin antibodies, which cause platelet activation.
Type i hit, also known as heparin associated thrombocytopenia hat, is a nonimmunologic response to heparin therapy, while type ii hit is an immunologic response to heparin therapy. In those cases, treatment that has a rapid onset of effect and is minimally. Heparininduced thrombocytopenia hit is a prothrombotic state associated with antiplatelet factor 4 pf4heparin antibodies, which cause platelet activation. Key clinical pointsheparin induced thrombocytopenia heparininduced thrombocytopenia hit is characterized by a decrease in the platelet count of more than 50% from the highest platelet count valu. Hit is usually an immune response which typically occurs 410 days after exposure to heparin. The end of gout is a short, to the point guide on how to reverse gout symptoms without ever leaving your home. The following guideline is intended to guide the diagnosis and management of heparin induced thrombocytopenia. In conjunction with this change, new guidelines for management of suspected hit and management of confirmed hit have also been developed. Thrombocytopenia is any disorder in which there are not enough platelets. Persistent heparininduced thrombocytopenia treated with ivig. Heparin induced thrombocytopenia hit is a complication of heparin therapy and is characterized by two types. It can occur after the administration of heparin that induces a heparin platelet factor 4 pf4 antibody complex, resulting in an immunemediated activation of platelets.
Recognition, treatment, and prevention of heparin induced thrombocytopenia. Heparininduced thrombocytopenia is a profoundly dangerous, potentially lethal, immunologically mediated adverse drug reaction to unfractionated heparin or, less commonly, to. This algorithm has been developed for md anderson using a multidisciplinary approach considering circumstances particular. Recent advances in the diagnosis and treatment of heparininduced. Because the platelet count normalizes even with continued heparin therapy, it is not associated with increased thrombotic risk. Heparin is widely used for the treatment and prophylaxis of thromboembolic diseases in medical and surgical patients.
Heparininduced thrombocytopenia hit is a life and limbthreatening condition caused by the binding of plateletactivating antibodies igg to multimolecular platelet factor 4 pf4heparin. Heparin, a negatively charged glycosaminoglycan 3,00030,000 da, is an anticoagulant released by mast cells and basophils during the normal clotting process. Timing of clinical sequelae, such as thrombocytopenia, thrombosis, or skin lesions. Heparin induced thrombocytopenia in the cardiovascular patient.
476 850 1022 56 1220 833 266 787 1534 959 594 1075 1119 678 1600 861 1364 268 1220 663 1453 908 555 377 71 136 142 735 237 258 1008 658 305 1145 881 1239 1324 87