Heparin-induced thrombocytopenia: Difference between revisions
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#Do not give platelts (may precipitate thrombosis) | #Do not give platelts (may precipitate thrombosis) | ||
#Start anticoagulation | #Start anticoagulation | ||
##Consider lepirudin, argatroban, danaparoid, fondaparinux, bivalirudin | ##Consider lepirudin (unless renal failure), argatroban (unless hepatobiliary disease), danaparoid, fondaparinux, bivalirudin | ||
##Avoid warfarin | ##Avoid warfarin until platelets >100 | ||
==See Also== | ==See Also== |
Revision as of 19:49, 14 October 2012
Background
- Despite low plt count pt is actually hypercoagulable; bleeding is unusual
- Pathophysiology
- Pathologic activation / consumption of platelets due to Ab against heparin-plt complex
- Activated platelets then cause blood clot formation
- Platelet count falls b/c plts are bound in clots
- Can be caused by unfrationated or LMWH (10x common in the former)
- Occurs in 0.5-5% of pts tx'd w/ heparin
- Thrombosis occurs in 35-75% of pts; 20-30% die w/in 1 month
Clinical Features
- Typical
- Symptoms begin 5-10d after initiation of heparin
- >50% decrease in plt count (median nadir is ~60K; rarely <20K)
- DVT or PE
- Cerebral vein or adrenal vein thrombosis
- Limb arterial occlusion
- CVA
- MI
- Skin necrosis
- Symptoms begin 5-10d after initiation of heparin
- Rapid onset
- Symptoms begin within hours of initiation of heparin
- Due to preexisting circulating antibody from sensitization several weeks earlier
- Sudden drop in plt count
- Thrombosis
- Flushing
- Tachycardia
- Hypotension
- Dyspnea
- Symptoms begin within hours of initiation of heparin
- Delayed onset
- Symptoms begin several days after heparin stopped
- Severe thromboses
Treatment
- Discontinue all heparin products
- Do not give platelts (may precipitate thrombosis)
- Start anticoagulation
- Consider lepirudin (unless renal failure), argatroban (unless hepatobiliary disease), danaparoid, fondaparinux, bivalirudin
- Avoid warfarin until platelets >100
See Also
Dispostion
- Admit
Source
Tintinalli