There are three anticoagulants for which there is an emerging consensus for their efficacy in management of HIT, and which are currently approved for treatment of HIT in several countries: the recombinant hirudin, lepirudin, a direct thrombin inhibitor; the synthetic direct thrombin inhibitor, argatroban; and the heparinoid, danaparoid sodium, mainly exhibiting antifactor-Xa activity.
What medications may be given for treatment of heparin-induced thrombocytopenia (HIT)?
What medications may be given for treatment of heparin-induced thrombocytopenia (HIT)? Select all that apply. Lepirudin Bivalirudin Argatroban
Which nonheparin anticoagulants are used in the treatment of hepatic thrombosis (hit)?
In patients with HIT with thrombosis (HITT) or isolated HIT who have normal renal function, we suggest the use of argatroban or lepirudin or danaparoid over other nonheparin anticoagulants (Grade 2C). In patients with HITT and renal insufficiency, we suggest the use of argatroban over other nonheparin anticoagulants (Grade 2C).
What is heparin induced thrombocytopenia?
Heparin-induced thrombocytopenia (HIT) is a condition that causes a decrease of platelets in the blood. Platelets help the blood clot. HIT usually occurs after you are treated with heparin. What increases my risk for HIT?
When should heparin not be initiated after a thrombotic event?
Taking care not to automatically initiate heparin if a patient is re‐admitted for a thrombotic event; the medical record must be thoroughly reviewed for use of heparin on a previous admission (within the past 100 days).
What medication class is used to prevent or treat heparin-induced thrombocytopenia HIT )?
Medications. Direct thrombin inhibitors (DTI) are a class of anticoagulant medications that do not cause HIT. These drugs are administered by continuous intravenous infusion.
How do you treat HIT Type 2?
Treatment: Treatment of type II HIT requires immediate discontinuation of all heparin products, including heparin infusions, heparin flushes, and heparin coated catheters used for hemodynamic monitoring. The use of an effective alternative anticoagulant also needs to be determined (See Table 2).
What is HIT heparin-induced thrombocytopenia?
Heparin-induced thrombocytopenia (HIT) is heparin's most clinically relevant nonhemorrhagic complication. It is an immune complication caused by antibodies directed to complexes containing heparin and an endogenous platelet protein, platelet factor 4 (PF4).
Why is argatroban used in HIT?
Argatroban is rapidly acting and has been shown to significantly reduce the risk of death or new thrombosis [Lewis et al. 2001]. Treatment of HIT with argatroban successfully lowers mortality rates from thrombosis without increased bleeding risk [Lewis et al. 2001].
What medication is used to treat HIT?
Bivalirudin and fondaparinux have been used to treat HIT in small case series. New oral anticoagulants, such as factor IIa and factor Xa inhibitors, may provide a novel treatment approach in HIT. Summary: First-line therapies for HIT are argatroban or lepirudin.
How is HIT heparin treated?
A direct thrombin inhibitor, such as lepirudin, danaparoid or argatroban, is considered the agent of choice for treatment of HIT.
Which is used as antidote for heparin?
If immediate reversal is required protamine sulfate will result in neutralization of heparin. The dose of protamine is based on the amount of heparin administered in the previous 2 hours using Table 2.
What is Hepburn medicine?
Descriptions. Heparin injection is an anticoagulant. It is used to decrease the clotting ability of the blood and help prevent harmful clots from forming in blood vessels. This medicine is sometimes called a blood thinner, although it does not actually thin the blood.
What type of anticoagulant is fondaparinux?
Fondaparinux (Arixtra) is a synthetic anticoagulant based on the pentasaccharide sequence that makes up the minimal antithrombin (AT) binding region of heparin. Similar to low molecular weight heparins, it is an indirect inhibitor of factor Xa, but it does not inhibit thrombin at all.
Can you use enoxaparin in HIT?
Patients with HIT may safely receive enoxaparin if their plasma does not aggregate platelets in the presence of enoxaparin.
What is the difference between argatroban and heparin?
Because argatroban does not resemble heparin, it does not cross-react with HIT antibodies,25 a disadvantage of low-molecular-weight heparin and danaparoid. Furthermore, being small and synthetic, argatroban does not induce formation of antibodies that can alter its clearance, a disadvantage of lepirudin.
How is argatroban given?
Initial Dosage: Initiate an infusion of Argatroban Injection at 25 mcg/kg/min and administer a bolus of 350 mcg/kg via a large bore intravenous line over 3 to 5 minutes (see Table 2). Check an activated clotting time (ACT) 5 to 10 minutes after the bolus dose is completed.
What is a low platelet count?
A low platelet count makes bleeding more likely. When drugs or medications are the causes of a low platelet count, it is called drug-induced thrombocytopenia. Heparin-induced thrombocytopenia is thrombocytopenia caused by the blood thinner heparin.
Is heparin a blood thinner?
Heparin-induced thrombocytopenia is thrombocytopenia caused by the blood thinner heparin. Note: There are currently no drugs listed for "Heparin-Induced Thrombocytopenia".
What is heparin induced thrombocytopenia?
Heparin‐induced thro mbocytopenia (HIT) is a potentially devastating immune mediated adverse drug reaction caused by the emergence of antibodies that activate platelets in the presence of heparin. Despite thrombocytopenia, bleeding is rare; rather, HIT is strongly associated with thromboembolic complications involving both ...
How long does it take for thrombocytopenia to appear after heparin?
onset of thrombocytopenia typically 5–10 days after initiation of heparin treatment, which can occur earlier with previous heparin exposure (within 100 days)
What happens when heparin binds to PF4?
When heparin binds with PF4, it undergoes a conformational change and becomes immunogenic (fig 11),), leading to the generation of heparin–PF4 antibodies (HIT antibodies), most frequently IgG.9The heparin–PF4–IgG multimolecular immune complex then activates platelets via their FcγIIa receptors, causing the release of prothrombotic platelet‐derived microparticles, platelet consumption, and thrombocytopenia.9These microparticles in turn promote excessive thrombin generation, frequently resulting in thrombosis. The antigen–antibody complexes also interact with monocytes, leading to tissue factor production, and antibody‐mediated endothelial injury may occur. Both of these latter processes may contribute further to the activation of the coagulation cascade and thrombin generation.
What is a HIT type?
HIT type I (also known as heparin‐associated thrombocytopenia) is a non‐immunologic response to heparin treatment , mediated by a direct interaction between heparin and circulating platelets causing platelet clumping or sequestration. HIT type I affects up to 10% of patients, usually occurs within the first 48–72 h after initiation of heparin treatment, and is characterised by a mild and transient thrombocytopenia (rarely <100 000/mm3), often returning to normal within 4 days once the heparin is withdrawn.4No laboratory tests are required to diagnose HIT type I, and it is not associated with an increased risk of thrombosis, whereas HIT type II is immune‐mediated and associated with a risk of thrombosis. It has recently been proposed that the term “HIT type I” be changed to “non‐immune heparin associated thrombocytopenia” and that the term “HIT type II” be changed to “HIT” to avoid confusion between the two syndromes.5
How long does it take for a platelet count to rise after heparin?
The platelet count starts to rise within 2–3 days and usually returns to normal within 4–10 days after cessation of heparin treatment, and it takes another 2–3 months for antibodies to disappear.13In patients with persistent or worsening thrombocytopenia despite absolute discontinuation of heparin, other possible causes of thrombocytopenia must be considered and investigated; a decision to recommence heparin should be made after careful risk–benefit analysis in individual patients.
What is the molecular weight of heparin?
Low molecular weight heparins (LMWH), molecular weight 2000–10 000 Daltons (Da), are produced by chemical or enzymatic processes from unfractionated heparins (UFH).6UFH are heterogenous mixture of negatively charged, sulfated glycosaminoglycan (3000–30 000 Da) derived from animal sources.6HIT is caused by the formation of antibodies that activate platelets following heparin administration.7The principal antigen is a complex of heparin and platelet factor 4 (PF4), a small positively charged molecule of uncertain biological function, normally found in α‐granules of platelets.8Heparin's high affinity for PF4 depends upon molecular weight, chain length and its degree of sulfation, which explains the differences in incidence of HIT observed with different heparins.8
What is thrombocytopenia in HIT?
Thrombocytopenia in HIT is largely due to the clearance of activated platelets and antibody‐coated platelets by the reticulo‐endothelial system.1
What is heparin-induced thrombocytopenia?
Heparin-induced thrombocytopenia (HIT) is a condition that causes a decrease of platelets in the blood. Platelets help the blood clot. HIT usually occurs after you are treated with heparin.
What is a heparin IV?
An IV or central line that is flushed with heparin or coated with heparin. A type of heparin used from cows or pigs. Taking heparin for more than 4 days. Female gender.
How is HIT treated?
All heparin treatments will stop, including heparin flushes and catheters coated with heparin. You may need any of the following:
What is the best medicine for blood clots?
Antiplatelets , such as aspirin, help prevent blood clots. Take your antiplatelet medicine exactly as directed. These medicines make it more likely for you to bleed or bruise. If you are told to take aspirin, do not take acetaminophen or ibuprofen instead.
How to keep your gums from bleeding when taking blood thinners?
Watch for blood in your urine and bowel movements. Use a soft washcloth on your skin, and a soft toothbrush to brush your te eth. This can keep your skin and gums from bleeding.
Can you take blood thinners with a bracelet?
Tell your dentist and other healthcare providers that you take a blood thinner. Wear a bracelet or necklace that says you take this medicine. Do not start or stop any other medicines unless your healthcare provider tells you to. Many medicines cannot be used with blood thinners.
Does heparin stop?
All heparin treatments will stop, including heparin flushes and catheters coated with heparin. You may need any of the following:
What are the factors that influence the choice of non-heparin anticoagulant?
The choice of non-heparin anticoagulant may also be influenced by drug factors (eg, availability, cost, route of administration), patient factors (eg, kidney function, liver function), and clinician experience . [ 47, 57] For example, in patients with HIT who have thrombosis and renal insufficiency, American College of Chest Physicians (ACCP) guidelines suggest using argatroban; in those with normal renal function, the ACCP suggests using argatroban, lepirudin, or danaparoid. [ 47]
Is bivalirudin a direct inhibitor?
Bivalirudin is a competitive, direct inhibitor of thrombin that inhibits both free and clot-bound thrombin and thrombin-induced platelet aggregation. This agent is approved for use in patients who are undergoing percutaneous coronary intervention (PCI) and have, or are at risk for, HIT or HIT with thrombosis (HITT).
Is argatroban a dialysis drug?
Argatroban is the ideal alternative to heparin for patients receiving dialysis, because it is not excreted by the kidneys and does not require dose adjustment in those patients. [ 51] . However, because argatroban is processed by the liver, the initial dose should be reduced by 75% in patients with liver dysfunction.
Does Fondaparinux affect platelet function?
Fondaparinux does not affect prothrombin time or aPTT, nor does it affect platelet function or aggregation. Warfarin (Coumadin, Jantoven) View full drug information. Warfarin interferes with hepatic synthesis of vitamin K–dependent coagulation factors. It is used for prophylaxis and treatment of venous thrombosis, pulmonary embolism, ...
Can heparin be used for thrombocytopenia?
Treatment of heparin-induced thrombocytopenia involves discontinuing heparin and starting a non-heparin anticoagulant. American Society of Hematology guidelines suggest that some agents may be preferred in certain circumstances, as follows [ 57] :
What does the nurse anticipate after reviewing a patient's hemoglobin electrophoresis report?
After reviewing a patient's hemoglobin electrophoresis reports, the nurse anticipates a diagnosis of sickle cell disease. Which data supports the nurse's suspicion? Select all that apply.
What is the role of a nurse in anemia?
The nurse is assessing the nutritional status of a patient with anemia. How does the nurse obtain information about the patient's diet?
How many oxygen molecules can hemoglobin transport?
Each hemoglobin molecule consists of one iron molecule, which can transport up to four molecules of oxygen. Two hemoglobin molecules can transport up to eight molecules of oxygen.
How long does it take for a blood sample to be prothrombin?
The prothrombin time (PT) of a patient's blood sample is 14 seconds . What does the nurse interpret from this lab result?
What does it mean when a nurse is caring for a patient with chronic kidney disease?
On reviewing the patient's laboratory results, the nurse finds that the red blood cell (RBC) count is greatly reduced.
What is a patient diagnosed with idiopathic thrombocytopenic purpura scheduled for?
A patient diagnosed with idiopathic thrombocytopenic purpura is scheduled for a splenectomy. What interventions are priority?
What is the platelet count of an ITP patient?
The nurse is caring for a patient diagnosed with idiopathic thrombocytopenic purpura (ITP). The patient's platelet count is 38,000/mm . What treatment does the nurse anticipate for this patient?
Is fibrin mesh inadequate to stop bleeding?
Formation of the fibrin mesh is inadequate to stop the bleeding.