Argatroban anticoagulation in patients with heparin-induced thrombocytopenia.
Treatment and prevention of heparin-induced thrombocytopenia. Lewis BE, Wallis DE, Berkowitz SD, et al. Warfarin should be initiated with a low maintenance dose (specifically, no loading dose) and overlapped with the non-heparin anticoagulant until the target international normalized ratio (INR) has been reached and for a minimum of 5 days.Patients who are taking warfarin therapy at the time of diagnosis with HIT are predisposed to venous limb gangrene and warfarin-induced central skin necrosis.As with most drug-induced thrombocytopenias, patients with a prior history of HIT should usually not be re-exposed to heparin. A metaanalysis. The thrombocytopenia is typically moderate, with a median platelet count nadir of ~50 to 60 × 10The development of thrombocytopenia or a new thrombus in a patient receiving heparin or a low-molecular weight heparin (LMWH) necessitates careful assessment for heparin-induced thrombocytopenia (HIT), an antibody-mediated complication of heparin therapy.Thrombocytopenia occurs quite frequently in hospitalized patients receiving heparin, but not all patients receiving heparin who are thrombocytopenic will have HIT. Lewis BE, Wallis DE, Leya F, Hursting MJ, Kelton JG. In 52 volunteers studied, an inverse correlation (r = -0.72, P less than 0.001) was observed between platelet count and MPV, suggesting that the circulating platelet mass may be a more important indicator of platelet homeostasis than either the platelet count or the mean platelet volume alone. Rauova L, Poncz M, McKenzie S, et al. In general, a platelet count more than 450,000 cells per microliter is considered elevated; this is known as thrombocytosis. No difference in risk for thrombocytopenia during treatment of pulmonary embolism and deep venous thrombosis with either low-molecular-weight heparin or unfractionated heparin. Learn about the five types of stroke medication here. PF4 is a CXC chemokine that binds to heparin and other negatively charged glycosaminoglycans with high affinity, in part because PF4 forms tetramers that have a circumferential belt of positively charged amino acids.Formation of complexes of PF4 and heparin leads to the exposure of neoepitopes, which results in the formation of the anti-heparin/PF4 antibodies that are identified in patients with the syndrome. Use a 60-inch microbore non-di-(2-ethylhexyl)phthalate (DEHP) extension set with proximal antisyphon valve, low-priming volume (0.9 mL), and in-line 0.22-micron filter. Janatpour K, Gosselin R, Dager W, et al. Guidelines for the Management of Anticoagulant and Anti-Platelet Agent Associated Bleeding Complications in Adults Purpose: To be used as a common tool for all practitioners involved in the care of patients who present with bleeding problems related to use of anticoagulant and anti-platelet agents. This benign process, sometimes referred to as heparin-associated thrombocytopenia, is not associated with an increased risk for thromboembolic events and needs to be clinically distinguished from HIT. However, anti-heparin/PF4 antibodies appear to not persist in the circulation and are frequently not detectable by 3 months after the diagnosis of HIT.In summary, the thrombocytopenia encountered in patients with HIT differs from other drug-induced thrombocytopenias in a number of important areas. 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