A case of heparininduced thrombocytopenia hit triggered by. The management of patients with heparin induced thrombocytopenia who require anticoagulant therapy kathryn hassell, md for patients with heparin induced thrombocytopenia hit, reexposure to heparin is generally not recommended. If the platelet count falls by 30% or more andor the patient develops new thrombosis or skin allergy or any of the other rarer manifestations of heparin. Heparin induced thrombocytopenia is a serious immunemediated, drug adverse effect. Patients with heparininduced thrombocytopenia present with mild thrombocytopenia. Do not send hit antibody testing elisa or serotonin release assay sra 4. Treatment involves prompt cessation of heparin and treatment with argatroban or offlabel fondaparinux. Heparininduced thrombocytopenia and thrombosis syndrome hitts is an immunemediated response to the administration of heparin that results in lifethreatening thrombosis. Heparininduced thrombocytopenia hit arup laboratories.
Heparininduced thrombocytopenia hit is an immune complication of heparin. The pretest probability of heparin induced thrombocytopenia. Heparininduced thrombocytopenia retrospective analysis. Laboratory testing reveals a platelet count of 86,000 per cubic. Each case had confounding features that delayed recognition of the problem. Target population adult patients with suspicion or diagnosis of heparin induced thrombocytopenia key practice recommendations screening for hit 1. Heparin therapy may sometimes be seriously complicated by heparin induced thrombocytopenia hit. Heparininduced thrombocytopenia, fifth edition fundamental.
Its diagnosis is based on a medical condition compatible with this syndrome and. This complication of heparin is often confusing because in hit, heparin. Persistent heparininduced thrombocytopenia treated with ivig. Hit develops in temporal association with heparin therapy and manifests either as an unexplained thrombocytopenia or thrombocytopenia complicated by thrombosis. Heparin induced thrombocytopenia kettering health network.
We describe a 58yearold nulliparous obese woman who developed severe. Treatment and prevention of heparininduced thrombocytopenia. The following guideline is intended to guide the management of heparin induced thrombocytopenia and includes recommendations for diagnosis and treatment agents. When drugs or medications are the causes of a low platelet count, it is called drug induced thrombocytope. Heparin induced thrombocytopenia diagnosis and management theodore e. Hit may also be associated with low molecular weight heparin use. Heparin induced thrombocytopenia hit is a serious adverse reaction that is caused by plateletactivating antiplatelet factor 4 pf4 heparin antibodies and leads to an. Start anticoagulation with no heparin based compound such as a direct thrombin inhibitor. Im going to reveal to you the secret method that allows you to get the equivalent exercise of 45 minutes at the gym, in just a few minutes per day.
Heparin induced thrombocytopenia hit heparin induced thrombocytopenia hit is a potentially lethal, immunologically induced complication to unfractionated heparin therapy and to a smaller degree, low molecular weight heparin. Heparin induced thrombocytopenia hit treatment page 1 of 7. Heparin induced thrombocytopenia hit is a complication of heparin therapy and is characterized by two types. The pathophysiology of hitts remains controversial. However, these patients are likely to require anticoagulation therapy at some point in the future. Hit usually occurs after you are treated with heparin. Riia thrombocytopenia high risk of thrombosis occurs in 50% of untreated cases may be venous dvt, pe or arterial limb ischemia, stroke, mi thrombotic complications can be fatal.
Because the platelet count normalizes even with continued heparin therapy, it is not associated with increased thrombotic risk. Diagnosing postoperative heparin induced thrombocytopenia hit in cardiothoracic surgical patients is complicated because of the profound thrombocytopenia that occurs with cardiopulmonary bypass cpb. Heparin induced thrombocytopenia hit occurs in two major forms type i, which is non immunologic and associated with mild transient thrombocytopenia, and type ii, caused by an. Hit occurs in up to 5% of patients receiving unfractionated heparin ufh, and in sep 08, 2010 gym guru exposes fat burning secret.
Halting heparininduced thrombocytopenia american nurse. In summary, hit is an immunemediated reaction to heparin therapy that results in decreased platelet counts and hypercoagulability and requires clinicopathologic correlation for accurate diagnosis. A 63yearold man with coronary artery disease who has recently undergone bypass surgery presents with dyspnea. Heparin induced thrombocytopenia mild to moderate thrombocytopenia or a 50 percent reduction after exposure to heparin or lowmolecularweight heparin arterial and venous thrombosis. Diagnosis requires the combination of a compatible clinical picture and laboratory confirmation of the presence of heparin dependent plateletactivating hit antibodies. Feb 03, 2020 heparin induced thrombocytopenia hit is a condition that causes a decrease of platelets in the blood. The most commonly used intravenous anticoagulant is heparin. Heparininduced thrombocytopenia hit is a lifethreatening immune response to heparin and its derivatives that is associated with a high risk of thromboembolic complications. Warkentin, md h eparin induced thrombocytopenia hit is an adverse drug reaction characterized by thrombocytopenia and a high risk for venous or arterial thrombosis. Heparininduced thrombocytopenia investigations bmj best. Heparininduced thrombocytopenia hit is by far the most relevant pathological association of it encountered by clinicians. Overview test information additional resources heparininduced thrombocytopenia hit is a complication of heparin therapy.
Heparin induced thrombocytopenia is the development of thrombocytopenia due to the administration of heparin. Heparin induced thrombocytopenia hit is a lifethreatening complication of exposure to heparin eg, unfractionated heparin, low molecular weight lmw heparin that occurs in a small percentage of patients exposed, regardless of the dose, schedule, or route of administration. Clinical picture of heparin induced thrombocytopenia hit and its differentiation from nonhit thrombocytopenia. Citations may include links to fulltext content from pubmed central and publisher web sites. Heparininduced thrombocytopenia clinical presentation. Hit is usually an immune response which typically occurs 410 days after exposure to heparin. None of the newer anticoagulants, whether oral or parenteral, combine. May 18 issue1 identified a difference in outcome favoring the use of lowmolecularweight heparin. Heparininduced thrombocytopenia article nursingcenter.
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. Heparin induced thrombocytopenia adult inpatient clinical. Heparininduced thrombocytopenia and thrombosis syndrome. Usually, heparin administered at or near surgery is the most immunizing situation i. Hit is an immunologic drug reaction mediated by the igg antibodies against the heparin platelet factor 4 pf4 complex.
A diagnosis of heparininduced thrombocytopenia with. Heparininduced thrombocytopenia what you need to know. This is the case of a patient with heparin induced thrombocytopenia hit, a syndrome that can be potentially fatal. Heparininduced thrombocytopenia history and exam bmj.
Smock, md associate professor of pathology, medical director, arup hemostasisthrombosis. Heparininduced thrombocytopenia hit is an adverse reaction to the drug heparin resulting in an abnormally low amount of platelets thrombocytopenia. Recent data show that up to 8% of heparinized patients will develop the antibody associated with hit and that approximately 15% of patients on heparin will progress to develop hit with thrombocytopenia. Diagnosis of heparin induced thrombocytopenia karen a. Heparininduced thrombocytopenia, fifthedition although first reported in 1973, immune heparin induced thrombocytopenia hit remains one of the most frequent and devastating. Heparin induced thrombocytopenia hit is a prothrombotic state associated with antiplatelet factor 4 pf4 heparin antibodies, which cause platelet activation. Hit is characterized by a 3050% drop in platelet count 5 to 10 days after heparin. Negatively charged heparin forms a complex with positively charged platelet factor 4 pf4 1. Heparininduced thrombocytopenia hit is a potentially life threatening complication. Pathogenesis and management heparin induced thrombocytopenia hit is a transient. This algorithm has been developed for md anderson using a multidisciplinary approach considering. Laboratory testing for the antibodies that cause heparin induced thrombocytopenia. The role of a bone marrow biopsy is to rule out other causes of thrombocytopenia or an underlying lymphoproliferative disorder.
Treatment of heparininduced thrombocytopenia involves discontinuing heparin and starting a non heparin anticoagulant. Heparin induced thrombocytopenia hit is considered the most common form of drug induced thrombocytopenia as well as one of the common causes of thrombocytopenia in hospitalized patients. 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 heparin induced thrombocytopenia hit can be defined as a decrease in platelet count that can occur during or shortly after exposure to heparin. Thrombocytopenia is any disorder in which there are not enough platelets. Hit is the most common type of drug induced, immunemediated thrombocytopenia and is associated with high morbidity and mortality if undiagnosed. The following guideline is intended to guide the diagnosis and management of heparin induced thrombocytopenia. Research over the last 20 years has vastly expanded knowledge, awareness and management of this condition. Heparin cessation and alternative anticoagulation are the key interventions in patients with hit. List of heparininduced thrombocytopenia medications. A severe drug reaction to heparin that can lead to life and limbthreatening venous andor arterial thromboembolism.
Guidelines for the investigation and management of idiopathic. The propensity for thrombosis distinguishes hit from other common drug induced. Heparininduced thrombocytopenia is the most important of the immunemediated, drug induced thrombocytopenias. Heparin induced thrombocytopenia in the cardiovascular patient. Heparin induced thrombocytopenia hit treatment page 1 of 7 disclaimer. The pathophysiology of heparin induced thrombocytopenia includes an immunemediated reaction to heparin that activates platelets and results in an acquired hypercoagulability. Moser, md heparin induced thrombocytopenia hit is a complication seen in approximately 1%3% of patients treated with unfractionated heparin therapy.
Impact of bovine versus porcine heparin in hit pathogenesis. 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. Based on the ethical guidelines for medical and health research involving human. 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. Putting the brakes on bleeding by clicking on the pdf icon above. Sample case 64 yo woman with endocarditis platelet count decreases from 161k on day 7 to 60k on day 9 been receiving low molecular weight heparin. Evans may have developed deep vein thrombosis or a complex coagulopathy, such as heparin induced thrombocytopenia hit.
Heparin induced thrombocytopenia hit is an immunemediated syndrome of thrombocytopenia and thrombosis as a result of heparin exposure. Complications of hit are venousarterial thrombosis, skin gangrene, and acute platelet activation syndrome. Understanding the misunderstood disease of heparin. Hit is considered to be the most important and most frequent drug induced type of thrombocytopenia. Heparin induced thrombocytopenia hit is an immunemediated hypercoagulable disorder caused by antibodies to platelet factor 4 pf4 and heparin. Heparininduced thrombocytopenia hit is an immune complication of heparin therapy caused by antibodies to complexes of platelet factor 4 pf4 and heparin. Heparin induced thrombocytopenia is a clinicopathologic syndrome that can be associated with severe complications and significant mortality. Heparininduced thrombocytopenia and cardiac surgery the. Cpb predisposes patients to develop a frequent incidence of antibodies directed against platelet factor 4 pf4 heparin. Guidelines on the diagnosis and management of heparin.
The onset of clinical symptoms and laboratory changes is usually delayed 12 weeks after exposure to heparin. Heparin induced thrombocytopenia was defined as a decrease in the platelet count below 150,000 per cubic millimeter that began five or more days after the start of heparin therapy, and a positive. Society for haematology and idiopathic thrombocytopenic purpura. Heparininduced 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. Heparin induced thrombocytopenia hit treatment page 1.
Heparin induced thrombocytopenia hit is an immune complication of heparin therapy caused by antibodies to complexes of platelet factor 4 pf4 and heparin. Hit results from an autoantibody directed against endogenous. In the group of 70 patients with a history of prior heparin therapy, seven 10% had thrombocytopenia. Heparininduced thrombocytopenia hit immune complexes heparinpf4igg cause platelet activation via the platelet fc. The use of heparin to flush some vascular access devices makes hit a concern for. Itp is a diagnosis of exclusion without an absolute confirmatory test. Pathogenic antibodies to pf4heparin bind and activate cellular fc. Heparininduced thrombocytopenia shaikh n j emerg trauma shock. Heparininduced thrombocytopenia in acute coronary syndrome. This article discusses the pathogenesis, diagnosis, and treatment of patients with heparin induced thrombocytopenia. Heparin use for treatment and prevention of thromboembolism is more common in the elderly and that may be the reason why hit is reported more frequently in this group of patients. Prospective evaluation of the 4ts score and particle gel immunoassay specific to heparin pf4 for the diagnosis of heparin induced thrombocytopenia. Our understanding of the pathophysiology of this immunemediated condition has improved in recent years, with heparin. Two clinical forms of hit are generally recognized.
Heparininduced thrombocytopenia hit is a potentially serious complication of heparin therapy and is being encountered more frequently in patients with cardiovascular disease as use of anticoagulant therapy becomes more widespread. Sometimes, these antibodies strongly activate platelets and coagulation, thereby causing the prothrombotic disorder, heparin induced thrombocytopenia. Haemodialysisrelatedheparininduced thrombocytopenia revista. The multiple causes and myriad presentations of thrombocytopenia. Ticagrelor causes falsenegative functional tests for. Hit results from an autoantibody directed against platelet factor 4. In a prospective study of 142 patients receiving intravenous heparin of bovine lung origin, thrombocytopenia developed in nine 6% patients. This cardiology patient page focuses on heparin induced thrombocytopenia hit, a complication of heparin therapy. Heparininduced thrombocytopenia in critically ill patients. Unfractionated heparin given during cardiopulmonary bypass is remarkably immunogenic, as 25% to 50% of postcardiac surgery patients develop heparin dependent antibodies during the next 5 to 10 days. Heparininduced thrombocytopenia genetic and rare diseases. The result is venous and occasionally arterial thrombosis. Key clinical pointsheparininduced thrombocytopenia heparininduced thrombocytopenia hit is characterized by a decrease in the platelet count of more than 50% from the highest platelet. Pubmed comprises more than 26 million citations for biomedical literature from medline, life science journals, and online books.
Thrombocytopenia is the most common sign of heparin induced thrombocytopenia hit. An iv or central line that is flushed with heparin or coated with heparin. Heparin induced thrombocytopenia hit is an immunemediated complication of heparin therapy. Heparin induced thrombocytopenia hit is an antibodymediated adverse drug reaction that can lead to devastating thromboembolic complications, including pulmonary embolism, ischemic.
Heparin induced thrombocytopenia hit is an antibodymediated adverse drug reaction that can lead to devastating thromboembolic complications, including pulmonary. Heparininduced thrombocytopenia hit is an immunemediated hypercoagulable disorder caused by antibodies to platelet factor 4 pf4 and heparin. Heparininduced thrombocytopenia hit is the development of thrombocytopenia a low platelet count, due to the administration of various forms of heparin, an anticoagulant. Target population adult patients with suspicion or diagnosis of heparin induced thrombocytopenia. May 03, 2012 heparin induced thrombocytopenia hit is an adverse reaction to the drug heparin resulting in an abnormally low amount of platelets thrombocytopenia. Heparininduced thrombocytopenia hit is a condition that causes a decrease of platelets in the blood. 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.
Heparininduced thrombocytopenia hit is an immune igg mediated condition that occurs secondary to heparin exposure. Heparin induced thrombocytopenia hit is a common and often severe complication of heparin therapy. Heparininduced thrombocytopenia, fifth edition fundamental and clinical cardiology warkentin, theodore e. Antiplateletantibodies are not thought to be sufficiently sensitive or specific to rule in or out itp. Heparin induced thrombocytopenia is an antibodymediated adverse drug reaction to heparin therapy with potentially lifethreatening complications. Heparininduced thrombocytopenia is a profoundly dangerous, potentially lethal, immunologically mediated adverse drug reaction to unfractionated heparin or, less commonly, to lowmolecular weight heparin. Riia on platelets and monocytes to propagate a hypercoagulable state culminating in lifethreatening thrombosis.
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