3,748 results match your criteria Heparin-Induced Thrombocytopenia


The Appropriateness of Testing Platelet Factor 4/Heparin Antibody in Patients Suspected of Heparin-induced Thrombocytopenia.

Cureus 2018 Oct 31;10(10):e3532. Epub 2018 Oct 31.

Hematology and Oncology, St. Vincent Hospital, Worcester, USA.

Heparin-induced thrombocytopenia (HIT) is an adverse reaction to the administration of heparin due to the activation of the platelets by the immunoglobulin G (IgG) antibody-platelet factor 4 (PF4)/heparin immune complex. Since the clinical outcome is uncertain (as it could be associated with significant morbidity and sometimes death), an early diagnosis and appropriate treatment are necessary. The 4Ts pretest clinical scoring system and testing for all anti-PF4/heparin antibodies can markedly improve the diagnosis and prompt adequate treatment. Read More

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http://dx.doi.org/10.7759/cureus.3532DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6318092PMC
October 2018

An international External Quality Assessment for laboratory diagnosis of Heparin-Induced Thrombocytopenia.

J Thromb Haemost 2019 Jan 14. Epub 2019 Jan 14.

Institut für Immunologie und Transfusionsmedizin, Universitätsmedizin Greifswald, Greifswald, Germany.

Objective: Heparin-induced thrombocytopenia (HIT) is a potentially life-threatening complication of heparin exposure. Diagnosis is most reliable using a combination of an enzyme-immunoassay (EIA) that detects antibodies against platelet factor 4 (PF4)/heparin complexes ("antigen" assay) and a "functional" assay that detects platelet-activating properties of the pathogenic HIT antibodies. No External Quality Assessment (EQA) is available for a combination of the tests. Read More

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http://dx.doi.org/10.1111/jth.14383DOI Listing
January 2019

Thrombotic Thrombocytopenic Purpura Following Aortic Valve Replacement with St. Jude Medical Trifecta Bio-Prosthesis.

Cardiol Res 2018 Dec 7;9(6):392-394. Epub 2018 Dec 7.

Oxford Heart Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.

Thrombocytopenia is a recognized complication following aortic valve replacement (AVR). While post-operative thrombotic thrombocytopenic purpura (TTP) is less common than heparin-induced thrombocytopenia (HIT), it is associated with high mortality and morbidity and prompt diagnosis and treatment is vital. In this case report, we describe the first reported case of TTP after AVR using the trifecta bio-prosthesis. Read More

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http://dx.doi.org/10.14740/cr780wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6306118PMC
December 2018

Anticoagulation of a Percutaneous Left Ventricular Assist Device Using a Low-Dose Heparin Purge Solution Protocol: A Case Series.

J Pharm Pract 2019 Jan 6:897190018822105. Epub 2019 Jan 6.

1 Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, Augusta, GA, USA.

Background:: Impella CP® is a percutaneous left ventricular assist device that requires a heparin-dextrose purge solution. The manufacturer recommends heparin 50 units/mL, but supratherapeutic anticoagulation has been observed with this concentration.

Objective:: The purpose of this evaluation was to observe the efficacy and safety of a low-dose heparin-based purge solution (25 units/mL in dextrose 20%). Read More

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http://dx.doi.org/10.1177/0897190018822105DOI Listing
January 2019

Limited impact of clinician education on reducing inappropriate PF4 testing for heparin-induced thrombocytopenia.

J Thromb Thrombolysis 2019 Jan 5. Epub 2019 Jan 5.

Division of Hematology/Oncology, Department of Medicine, Medical University of South Carolina, 39 Sabin St, MSC 635, Charleston, SC, 29425, USA.

A high frequency of PF4-ELISA testing in patients suspected to have heparin-induced thrombocytopenia (HIT) despite low 4T scores has been observed in multiple medical centers. Education of clinicians has been suggested to reduce inappropriate testing. We determined trends of PF4-ELISA testing in our institution after the introduction of a HIT education program for clinicians. Read More

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http://dx.doi.org/10.1007/s11239-018-01803-8DOI Listing
January 2019

A 24-hour perioperative case study on argatroban use for left ventricle assist device insertion during cardiopulmonary bypass and veno-arterial extracorporeal membrane oxygenation.

Perfusion 2018 Dec 25:267659118813043. Epub 2018 Dec 25.

3 Division of Cardiac Surgery, London Health Sciences Centre, London, Ontario, Canada.

A 44-year-old male with ongoing chest pain and left ventricular ejection fraction <20% was transferred from a peripheral hospital with intra-aortic balloon pump placement following a non-ST-elevation myocardial infarction (STEMI). The patient underwent emergent multi-vessel coronary artery bypass grafting requiring veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) on post-operative day (POD)#9 secondary to cardiogenic shock with biventricular failure. Due to clot formation, an oxygenator change-out was necessary shortly after initiation. Read More

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http://dx.doi.org/10.1177/0267659118813043DOI Listing
December 2018
4 Reads
1.083 Impact Factor

Characterization of platelet factor 4 amino acids that bind pathogenic antibodies in heparin-induced thrombocytopenia.

J Thromb Haemost 2018 Dec 24. Epub 2018 Dec 24.

Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada.

Background: Heparin-induced thrombocytopenia (HIT) is an adverse drug reaction that results in thrombocytopenia and in some patients, thrombotic complications. HIT is mediated by antibodies that bind to complexes of platelet factor 4 (PF4) and heparin. The antigenic epitopes of these anti-PF4/heparin antibodies have not yet been precisely defined, because of the polyspecific immune response that characterizes HIT. Read More

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http://dx.doi.org/10.1111/jth.14369DOI Listing
December 2018

Fibronectin modulates formation of PF4/heparin complexes and is a potential factor for reducing risk of developing HIT.

Blood 2018 Dec 20. Epub 2018 Dec 20.

Institut fuer Immunologie und Transfusionsmedizin, Universitaet Greifswald, Germany;

Heparin-induced thrombocytopenia (HIT) is caused by platelet-activating anti-PF4/heparin antibodies. Platelet activation assays that utilize "washed" platelets are more sensitive for detecting HIT antibodies than platelet-rich plasma (PRP)-based assays. Moreover, heparin-exposed patients vary considerably with respect to risk of PF4/heparin immunization and-among antibody-positive patients-risk of subsequent "breakthrough" of clinical HIT with manifestation of thrombocytopenia. Read More

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http://dx.doi.org/10.1182/blood-2018-05-850370DOI Listing
December 2018
4 Reads

Recombinant Heparin-New Opportunities.

Front Med (Lausanne) 2018 4;5:341. Epub 2018 Dec 4.

TEGA Therapeutics, Inc., La Jolla, CA, United States.

Heparin and heparan sulfate (HS) are polydisperse mixtures of polysaccharide chains between 5 and 50 kDa. Sulfate modifications to discreet regions along the chains form protein binding sites involved in cell signaling cascades and other important cellular physiological and pathophysiological functions. Specific protein affinities of the chains vary among different tissues and are determined by the arrangements of sulfated residues in discreet regions along the chains which in turn appear to be determined by the expression levels of particular enzymes in the biosynthetic pathway. Read More

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http://dx.doi.org/10.3389/fmed.2018.00341DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6288228PMC
December 2018

An unusual case of bilateral pulmonary embolism in a patient on dual venous thromboprophylaxis, secondary to heparin induced thrombocytopenia.

J Community Hosp Intern Med Perspect 2018 11;8(6):376-379. Epub 2018 Dec 11.

Department of Medicine, Pulmonary and Critical Care Division, Interfaith Medical Center, Brooklyn, NY, USA.

Heparin Induced thrombocytopenia (HIT) is a rare, immune-mediated complication of heparin, associated with both thrombocytopenia and paradoxical thrombotic events. Initial diagnosis is made clinically when platelet count falls by 30% to <100 × 10cells/l or a > 50% decrease from baseline count in association with heparin therapy. Thromboembolic complications are seen in 50% of the cases. Read More

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http://dx.doi.org/10.1080/20009666.2018.1554099DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6292353PMC
December 2018
1 Read

Rare heparin induced thrombocytopenia type I reaction in a hemodialysis patient: Case report.

Medicine (Baltimore) 2018 Dec;97(50):e13609

Department of Pharmacy.

Rationale: Heparin-induced thrombocytopenia (HIT) is a common antibody-mediated adverse reaction that occurs after heparin exposure. However, few case reports exist regarding nonantibody-mediated HIT.

Patient Concerns And Diagnoses: An 81-year-old female diagnosed with rapidly progressive glomerulonephritis (RPGN) presented with atypical presentation of non antibody-meditated HIT after using heparin during hemodialysis. Read More

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http://dx.doi.org/10.1097/MD.0000000000013609DOI Listing
December 2018
5.723 Impact Factor

Use of intravenous immunoglobulin G to treat spontaneous heparin-induced thrombocytopenia.

Transfusion 2018 Dec 17. Epub 2018 Dec 17.

Medical Sciences Institute, BloodCenter of Wisconsin, Milwaukee, Wisconsin.

Background: Spontaneous heparin-induced thrombocytopenia (HIT) is a rare but serious prothrombotic syndrome characterized by thrombosis, thrombocytopenia, and strong platelet-activating HIT antibodies in the absence of heparin exposure, and is frequently characterized by a suboptimal response to standard therapies. Here, we present the first report of intravenous immunoglobulin G (IVIG) use in a patient with spontaneous HIT.

Study Design And Methods: Patient information, including demographic, clinical, and laboratory results, were obtained from the electronic medical record. Read More

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http://dx.doi.org/10.1111/trf.15105DOI Listing
December 2018
2 Reads

A Computerized Scoring System to Improve Assessment of Heparin-induced Thrombocytopenia Risk.

J Thromb Haemost 2018 Dec 14. Epub 2018 Dec 14.

University of Arizona College of Medicine - Phoenix, Division of Clinical Data Analytics and Decision Support, Phoenix, Arizona.

Background: Heparin induced thrombocytopenia (HIT) is an immune-mediated adverse drug event associated with life-threatening thrombotic complications. The four T's (4Ts) score is widely used to estimate the risk for HIT and guide diagnostic testing, but it is not easily amenable to computerized clinical decision support (CDS) implementation.

Objectives: Our main objective was to develop a HIT computerized risk (HIT-CR) scoring system that provides platelet count surveillance for timing and degree of thrombocytopenia to identify those for whom diagnostic testing should be considered. Read More

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http://dx.doi.org/10.1111/jth.14359DOI Listing
December 2018

The Association Between Human Leukocyte Antigens and ITP, TTP, and HIT.

J Pediatr Hematol Oncol 2019 Jan 4. Epub 2019 Jan 4.

Thalassemia and Hemoglobinopathy Research Center, Research Institute of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

Background: Autoimmune thrombocytopenia in immune thrombocytopenic purpura (ITP), thrombotic thrombocytopenic purpura (TTP), and heparin-induced thrombocytopenia (HIT) is associated with immunologic degradation of platelets and reduced platelet counts in patients, leading to bleeding risk in patients. Considering the role of human leukocyte antigens (HLA) in the development of immune response, in this review, we examine the relationship between HLA and pathogenesis of the above-mentioned diseases.

Methods: Relevant English-language literature was searched and retrieved from Google Scholar search engine and PubMed database (1979 to 2018). Read More

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http://dx.doi.org/10.1097/MPH.0000000000001381DOI Listing
January 2019

Direct-Thrombin Inhibitor Utilization in Patients With Heparin-Induced Thrombocytopenia and Undergoing Catheter-Directed Thrombolysis: A Summary of Published Case Reports.

J Cardiovasc Nurs 2018 Dec 11. Epub 2018 Dec 11.

Hisham A. Badreldin, PharmD, BCPS, ASH-CHC Assistant Professor of Pharmacy Practice, King Saud bin Abdulaziz University for Health Sciences, and Cardiovascular Clinical Pharmacist, King Abdulaziz Cardiac Center, King Abdulaziz Medical City, Riyadh, Saudi Arabia. Ghada Albassam, PharmD Teaching Assistant of Pharmacy Practice, King Saud bin Abdulaziz University for Health Sciences, and Pharmacist, King Abdulaziz Medical City, Riyadh, Saudi Arabia. Maha Aldoughaim, PharmD Teaching Assistant of Pharmacy Practice, King Saud bin Abdulaziz University for Health Sciences, and Pharmacist, King Abdulaziz Medical City, Riyadh, Saudi Arabia. Majed Alyami, PharmD, BCPS, ASH-CHC Assistant Professor of Pharmacy Practice, King Saud bin Abdulaziz University for Health Sciences, and Clinical Pharmacist, King Abdulaziz Medical City, Riyadh, Saudi Arabia.

Background: Catheter-directed thrombolysis (CDT) is one of the emerging venous thromboembolism management modalities. There are fairly limited data regarding the use of direct-thrombin inhibitors (DTIs) in patients with heparin-induced thrombocytopenia and undergoing CDT.

Objectives: The aim of this study was to provide a summary of the available evidence supporting the use of DTIs in patients undergoing CDT. Read More

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http://dx.doi.org/10.1097/JCN.0000000000000555DOI Listing
December 2018
1 Read
1.809 Impact Factor

Extracorporeal immunoadsorption in heparin- and protamine-induced thrombocytopaenia prior to cardiac surgery.

Eur J Cardiothorac Surg 2018 Dec 11. Epub 2018 Dec 11.

Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Division of Cardiac Thoracic Vascular Anaesthesia and Intensive Care Medicine, Medical University of Vienna, Vienna, Austria.

Exposure to heparin and protamine during cardiac surgery on cardiopulmonary bypass (CPB) may trigger heparin-induced thrombocytopaenia and/or protamine-induced thrombocytopaenia. Further surgery on CPB with heparin and protamine in the presence of these antibodies implies increased thromboembolic risk. We present the successful application of extracorporeal immunoadsorption to deplete antibodies causing heparin-induced and protamine-induced thrombocytopaenia preoperatively. Read More

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https://academic.oup.com/ejcts/advance-article/doi/10.1093/e
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http://dx.doi.org/10.1093/ejcts/ezy411DOI Listing
December 2018
1 Read

Distinct Binding Characteristics of Pathogenic Anti-Platelet Factor-4/Polyanion Antibodies to Antigens Coated on Different Substrates: A Perspective on Clinical Application.

ACS Nano 2018 Dec 12. Epub 2018 Dec 12.

Institute for Immunology and Transfusion Medicine , University Medicine Greifswald , 17475 Greifswald , Germany.

The polyanion heparin, which is frequently used in patients, complexes with the platelet-derived cationic chemokine platelet factor (PF4, CXCL4). This results in the formation of anti-PF4/heparin antibodies (anti-PF4/H Abs). Anti-PF4/H Abs are classified into three groups: (i) nonpathogenic Abs (group 1) with no clinical relevance; (ii) pathogenic heparin-dependent Abs (group 2), which activate platelets and can cause the severe adverse drug effect heparin-induced thrombocytopenia (HIT); and (iii) pathogenic autoimmune-HIT Abs (group 3), in which group 3 anti-PF4/H Abs causes a HIT-like autoimmune disease in the absence of heparin. Read More

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http://pubs.acs.org/doi/10.1021/acsnano.8b04487
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http://dx.doi.org/10.1021/acsnano.8b04487DOI Listing
December 2018
2 Reads

Literature review of apheresis procedures performed perioperatively in cardiac surgery for ASFA category indications.

J Clin Apher 2018 Dec 8. Epub 2018 Dec 8.

Department of Clinical Hematology - Blood Bank and Hemostasis, Onassis Cardiac Surgery Center, Kallithea, Greece.

Background: Perioperative therapeutic plasma exchange in patients with cardiovascular diseases poses several challenges, including alterations in intravascular volume, serum electrolytes, the coagulation cascade, and drug pharmacokinetics.

Methods: This review article summarizes different indications of plasma exchange for patients requiring cardiac surgery based on reported case reports and case series.

Results: The most common reported indication is plasma exchange for the management of allosensitized cardiac transplant candidate patients in combination with immunosuppressive regimens, which increases the likelihood of obtaining a cross-match-negative allograft, improving post-transplant clinical outcome. Read More

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http://dx.doi.org/10.1002/jca.21676DOI Listing
December 2018
1 Read

Rotational Thromboelastometry for Coagulation Management During Cardiopulmonary Bypass Using Argatroban.

J Cardiothorac Vasc Anesth 2018 Sep 25. Epub 2018 Sep 25.

Department of Cardiovascular Surgery, IMS Tokyo Katsushika General Hospital, Tokyo, Japan.

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http://dx.doi.org/10.1053/j.jvca.2018.09.028DOI Listing
September 2018

Heparin-induced thrombocytopenia suggested by microscopic examination of a below-knee amputation.

Transfusion 2018 Dec;58(12):2784-2785

Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York.

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http://doi.wiley.com/10.1111/trf.14815
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http://dx.doi.org/10.1111/trf.14815DOI Listing
December 2018
16 Reads
3.225 Impact Factor

Prospective Evaluation of a Rapid Functional Assay for Heparin-Induced Thrombocytopenia Diagnosis in Critically Ill Patients.

Crit Care Med 2018 Nov 30. Epub 2018 Nov 30.

Division of Hematology Laboratory, Thrombosis and Hemostasis Center, Tenon Hospital, APHP.6, Sorbonne Université, HUEP Paris, France.

Objectives: Overdiagnosis of heparin-induced thrombocytopenia remains an unresolved issue in the ICU leading to the unjustified switch from heparin to alternative anticoagulants or delays in anticoagulation. Platelet function assays significantly improve the specificity of heparin-induced thrombocytopenia diagnosis, but they are not readily available, involve technical difficulties and have a long turnaround time. We evaluated the performance of a rapid and easy to perform functional assay for heparin-induced thrombocytopenia diagnosis in ICU patients, known as "heparin-induced multiple electrode aggregometry. Read More

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http://dx.doi.org/10.1097/CCM.0000000000003574DOI Listing
November 2018
1 Read

Drug-associated thrombocytopenia.

Hematology Am Soc Hematol Educ Program 2018 11;2018(1):576-583

Transfusion Medicine, Medical Faculty of Tubingen, University of Tubingen, Tubingen, Germany.

Many drugs have been implicated in drug-induced immune thrombocytopenia (DITP). Patients with DITP develop a drop in platelet count 5 to 10 days after drug administration with an increased risk of hemorrhage. The diagnosis of DITP is often challenging, because most hospitalized patients are taking multiple medications and have comorbidities that can also cause thrombocytopenia. Read More

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http://dx.doi.org/10.1182/asheducation-2018.1.576DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6246020PMC
November 2018
4 Reads

Adult and pediatric mechanical circulation: a guide for the hematologist.

Hematology Am Soc Hematol Educ Program 2018 11;2018(1):507-515

Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.

Mechanical circulatory support (MCS) is the overarching term that encompasses the temporary and durable devices used in patients with severe heart failure. MCS disturbs the hematologic and coagulation system, leading to platelet activation, activation of the contact pathway of coagulation, and acquired von Willebrand syndrome. Ischemic stroke and major hemorrhage occur in up to 30% of patients. Read More

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http://dx.doi.org/10.1182/asheducation-2018.1.507DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6245997PMC
November 2018
1 Read

Anticoagulating patients with high-risk acquired thrombophilias.

Authors:
Leslie Skeith

Hematology Am Soc Hematol Educ Program 2018 11;2018(1):439-449

Division of Hematology and Hematological Malignancies, Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Canada; and Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.

Antiphospholipid syndrome (APS), heparin-induced thrombocytopenia, and paroxysmal nocturnal hemoglobinuria are 3 acquired thrombophilias that carry a high risk of venous and arterial thromboembolism. Management of these conditions has largely included anticoagulation with a vitamin K antagonist after an initial period of a parenteral anticoagulant, for as long as the thrombotic risk is still present. The available evidence for the use of direct oral anticoagulants (DOACs) is limited and primarily consists of case series and cohort studies, which are summarized in this chapter. Read More

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http://dx.doi.org/10.1182/asheducation-2018.1.439DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6246016PMC
November 2018
1 Read

Heparin-Induced Thrombocytopenia: A Review for Cardiac Anesthesiologists and Intensivists.

J Cardiothorac Vasc Anesth 2019 02 26;33(2):511-520. Epub 2018 Oct 26.

Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA. Electronic address:

Patients undergoing cardiovascular surgery may be exposed to heparin before surgery, during cardiopulmonary bypass (CPB), or in the immediate postoperative period. For this reason, cardiovascular surgery patients are at increased risk for heparin-induced thrombocytopenia (HIT), occurring in 1 to 3% of patients. The diagnosis of HIT can be difficult, if based solely on the development of thrombocytopenia, because cardiac surgical patients have multiple reasons to be thrombocytopenic. Read More

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http://dx.doi.org/10.1053/j.jvca.2018.10.035DOI Listing
February 2019
1 Read

American Society of Hematology 2018 guidelines for management of venous thromboembolism: heparin-induced thrombocytopenia.

Blood Adv 2018 Nov;2(22):3360-3392

Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada; and.

Background: Heparin-induced thrombocytopenia (HIT) is an adverse drug reaction mediated by platelet-activating antibodies that target complexes of platelet factor 4 and heparin. Patients are at markedly increased risk of thromboembolism.

Objective: These evidence-based guidelines of the American Society of Hematology (ASH) are intended to support patients, clinicians, and other health care professionals in their decisions about diagnosis and management of HIT. Read More

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http://www.bloodadvances.org/lookup/doi/10.1182/bloodadvance
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http://dx.doi.org/10.1182/bloodadvances.2018024489DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6258919PMC
November 2018
23 Reads

Increased risk of heparin induced thrombocytopenia and thrombosis in patients with essential thrombocythemia carrying the homozygous JAK2 V617F mutation.

J Thromb Thrombolysis 2018 Nov 26. Epub 2018 Nov 26.

Department of Biomedical and Clinical Sciences Luigi Sacco, Luigi Sacco Hospital, University of Milan, Milan, Italy.

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http://dx.doi.org/10.1007/s11239-018-1773-4DOI Listing
November 2018
1 Read

Development of a method to analyze the complexes of enoxaparin and platelet factor 4 with size-exclusion chromatography.

J Pharm Biomed Anal 2019 Feb 16;164:668-671. Epub 2018 Nov 16.

Jiangsu Key Laboratory of Translational Research and Therapy for Neuro-Psycho-Diseases and College of Pharmaceutical Sciences, Soochow University, Suzhou, Jiangsu, 215021, China. Electronic address:

Heparin, a highly sulfated glycosaminoglycan, has been used as a clinical anticoagulant over 80 years. However, heparin-induced thrombocytopenia and thrombosis (HITT) is a serious side effect of heparin therapy, resulting in relatively high risk of amputation and even death. HITT is caused by forming of complexes between heparin and platelet factor 4 (PF4). Read More

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http://dx.doi.org/10.1016/j.jpba.2018.11.018DOI Listing
February 2019
1 Read

Anticoagulating patients with high-risk acquired thrombophilias.

Authors:
Leslie Skeith

Blood 2018 Nov;132(21):2219-2229

Division of Hematology and Hematological Malignancies, Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Canada; and Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.

Antiphospholipid syndrome (APS), heparin-induced thrombocytopenia, and paroxysmal nocturnal hemoglobinuria are 3 acquired thrombophilias that carry a high risk of venous and arterial thromboembolism. Management of these conditions has largely included anticoagulation with a vitamin K antagonist after an initial period of a parenteral anticoagulant, for as long as the thrombotic risk is still present. The available evidence for the use of direct oral anticoagulants (DOACs) is limited and primarily consists of case series and cohort studies, which are summarized in this chapter. Read More

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http://dx.doi.org/10.1182/blood-2018-05-848697DOI Listing
November 2018
1 Read

Prospective comparison of the HEP score and 4Ts score for the diagnosis of heparin-induced thrombocytopenia.

Blood Adv 2018 Nov;2(22):3155-3162

Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.

The HIT Expert Probability (HEP) score compared favorably with the 4Ts score in a retrospective study. We assessed the diagnostic accuracy of the HEP score compared with the 4Ts score in a prospective cohort of 310 patients with suspected heparin-induced thrombocytopenia (HIT). A member of the clinical team calculated the HEP score and 4Ts score. Read More

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http://dx.doi.org/10.1182/bloodadvances.2018023077DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6258908PMC
November 2018
1 Read

Use of argatroban for extracorporeal life support in patients with nonheparin-induced thrombocytopenia: Analysis of 10 consecutive patients.

Medicine (Baltimore) 2018 Nov;97(47):e13235

Department of Thoracic and Cardiovascular Surgery.

Unfractionated heparin (UFH) is currently the standard anticoagulant used in extracorporeal life support (ECLS). However, severe thrombocytopenia occurs frequently during ECLS use and it may be difficult to determine whether this represents heparin-induced thrombocytopenia (HIT) or not. In this case, UFH cannot be continued. Read More

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http://dx.doi.org/10.1097/MD.0000000000013235DOI Listing
November 2018
2 Reads

Successful treatment of heparin-induced thrombocytopenia with apixaban in a patient with chronic kidney disease requiring hemodialysis.

Clin Case Rep 2018 Nov 25;6(11):2147-2149. Epub 2018 Sep 25.

Hematology Hospital Pablo Tobón Uribe Medellin Colombia.

Heparin-induced thrombocytopenia (HIT) is a prothrombotic state that can affect patients with chronic kidney disease (CKD) on hemodialysis (HD). This case highlights the potential usefulness of apixaban therapy for patients with HIT and CKD on HD. Read More

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http://dx.doi.org/10.1002/ccr3.1817DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6230604PMC
November 2018

Heparin-Induced Thrombocytopenia and Cardiac Surgery.

Semin Thorac Cardiovasc Surg 2018 Nov 15. Epub 2018 Nov 15.

Division of Cardiovascular Medicine, University of Virginia, Charlottesville, Virginia. Electronic address:

Heparin-induced thrombocytopenia (HIT) is an immune-mediated condition characterized by thrombocytopenia with possible arterial and/or venous thrombosis. The overall incidence of HIT is low but ranges from 0.1% to 5%. Read More

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http://dx.doi.org/10.1053/j.semtcvs.2018.10.011DOI Listing
November 2018
7 Reads

Profiling Heparin-Induced Thrombocytopenia (HIT) Antibodies in Hospitalized Patients With and Without Diabetes.

Clin Appl Thromb Hemost 2018 Nov 12:1076029618808915. Epub 2018 Nov 12.

1 Health Sciences Division, Cardiovascular Research Institute, Loyola University Chicago, Maywood, IL, USA.

Heparin (H) anticoagulation in populations characterized by elevated platelet factor 4 (PF4) frequently elicits PF4/H antibodies, presenting a risk of heparin-induced thrombocytopenia. Recent studies have shown that anti-PF4/H enzyme-linked immunosorbent assays (ELISAs) detect antibodies in individuals never exposed to heparin. Platelet factor 4/H cross-reactive antibodies may result from PF4-mediated defense responses to injury or infection. Read More

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http://journals.sagepub.com/doi/10.1177/1076029618808915
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http://dx.doi.org/10.1177/1076029618808915DOI Listing
November 2018
10 Reads

Serotonin release assay (SRA)-negative HIT, a newly recognized entity: Implications for diagnosis and management.

Thromb Res 2018 12 27;172:169-171. Epub 2018 Oct 27.

Bloodcenter of Wisconsin, Milwaukee, WI, United States of America; Medical College of Wisconsin, Milwaukee, WI, United States of America.

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http://dx.doi.org/10.1016/j.thromres.2018.10.022DOI Listing
December 2018
2 Reads

Pharmacogenetic considerations of anticoagulant medication.

J Physiol Pharmacol 2018 Aug 10;69(4). Epub 2018 Nov 10.

Department of Pharmacodynamics, Medical University of Bialystok, Bialystok, Poland.

Predicting the clinical consequences of anticoagulant therapy by identifying gene variants could help in the risk assessment of thrombosis or bleeding before and after surgery and may result in choosing more beneficial therapy. This work provides an overview of pharmacogenetic data of commonly used anticoagulant medication. The review focuses on polymorphisms influencing the efficacy and safety of the parenteral and oral anticoagulants. Read More

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http://dx.doi.org/10.26402/jpp.2018.4.01DOI Listing
August 2018
6 Reads

Heparin-induced thrombocytopenia and sepsis.

Thromb Res 2018 12 31;172:119. Epub 2018 Oct 31.

Surgical, Medical and Dental Department of Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Italy.

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http://dx.doi.org/10.1016/j.thromres.2018.10.029DOI Listing
December 2018
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Plasma exchange for heparin-induced thrombocytopenia in patients on extracorporeal circuits: A challenging case and a survey of the field.

J Clin Apher 2019 Feb 8;34(1):64-72. Epub 2018 Nov 8.

Department of Pathology, The University of Chicago, Chicago, Illinois.

Current management of heparin-induced thrombocytopenia (HIT) involves prompt discontinuation of all heparin products and concomitant initiation of a direct thrombin or anti-Xa inhibitor for anticoagulation. In the setting of HIT complicated by an urgent need for cardiopulmonary bypass (CPB), the safety and the efficacy of short-term heparin-based anticoagulation after therapeutic plasma exchange (TPE) have been previously demonstrated. Patients with HIT requiring TPE are frequently on extracorporeal circuits (either CPB, extracorporeal membrane oxygenation [ECMO] or external ventricular assist devices [VADs]). Read More

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http://doi.wiley.com/10.1002/jca.21671
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http://dx.doi.org/10.1002/jca.21671DOI Listing
February 2019
8 Reads

An update on evidence based diagnostic and confirmatory testing strategies for heparin induced thrombocytopenia using combined immunological and functional assays.

Transfus Apher Sci 2018 Dec 30;57(6):804-811. Epub 2018 Oct 30.

International Consultancy in Blood Components Quality/Safety Improvement, Audit/ Inspection and DDR Strategies, London, UK. Electronic address:

This manuscript aims to provide a concise review on current diagnostic/ confirmatory strategies of Heparin Induced Thrombocytopenia (HIT) with the combined use of immunological / functional assays in addition to the clinical probability. Laboratory diagnosis of HIT is of primordial importance as the related complications could become rapidly severe and life-threatening and can provoke limb amputation in some cases. The first action in the presence of HIT suspicion is to withdraw heparin and to initiate an alternative anticoagulant. Read More

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https://linkinghub.elsevier.com/retrieve/pii/S14730502183043
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http://dx.doi.org/10.1016/j.transci.2018.10.019DOI Listing
December 2018
10 Reads

Pharmacogenetics to prevent heparin-induced thrombocytopenia: what do we know?

Authors:
Jason H Karnes

Pharmacogenomics 2018 Dec 6;19(18):1413-1422. Epub 2018 Nov 6.

Department of Pharmacy Practice & Science, University of Arizona College of Pharmacy, Tucson, AZ 85721, USA.

Heparin-induced thrombocytopenia (HIT) is a life-threatening, immune-mediated adverse reaction to heparin anticoagulants. The inability to predict HIT represents a considerable liability associated with heparin administration. Genetic studies of HIT are challenging due to the scarcity of true HIT cases, potential for misclassification, and many environmental risk factors. Read More

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https://www.futuremedicine.com/doi/10.2217/pgs-2018-0147
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http://dx.doi.org/10.2217/pgs-2018-0147DOI Listing
December 2018
14 Reads

Heparin-induced thrombocytopaenia diagnostic testing after adult cardiac surgery: a single-centre experience and development.

Eur J Cardiothorac Surg 2018 Nov 5. Epub 2018 Nov 5.

Division of Cardiothoracic and Vascular Anaesthesia and Intensive Care, Department of Anesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria.

Objectives: To assess the incidence and outcome of heparin-induced thrombocytopaenia (HIT) in patients after cardiac surgery on cardiopulmonary bypass (CPB) and to review the time course of platelet counts and the use of different immunological diagnostic tests.

Methods: All patients ≥18 years of age who underwent CPB from 2006 to 2015 and who were postoperatively admitted to our cardiac intensive care unit (ICU) were included in this retrospective study. Screening for heparin/platelet factor-4 antibodies was performed using an antibody test, which was later replaced with a screening test specific for IgG antibodies without IgA/IgM cross-reactivity. Read More

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https://academic.oup.com/ejcts/advance-article/doi/10.1093/e
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http://dx.doi.org/10.1093/ejcts/ezy350DOI Listing
November 2018
7 Reads

Systematic review of fondaparinux for heparin-induced thrombocytopenia: When there are no randomized controlled trials.

Res Pract Thromb Haemost 2018 Oct 9;2(4):678-683. Epub 2018 Aug 9.

Department of Medicine Michael G. DeGroote School of Medicine McMaster University Hamilton Ontario Canada.

Background: Fondaparinux is commonly used for treatment of heparin-induced thrombocytopenia (HIT) despite lack of approval for this indication. High quality randomized controlled trials of this agent are unlikely to be forthcoming.

Objectives: The objective of this systematic review is to update the literature on the efficacy and safety of fondaparinux for treatment of confirmed and probable HIT based on the available evidence. Read More

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http://doi.wiley.com/10.1002/rth2.12145
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http://dx.doi.org/10.1002/rth2.12145DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6178656PMC
October 2018
8 Reads

Evaluation of unfractionated heparin versus low-molecular-weight heparin and fondaparinux for pharmacologic venous thromboembolic prophylaxis in critically ill patients with cancer.

J Thromb Haemost 2018 Dec 15;16(12):2492-2500. Epub 2018 Nov 15.

Department of Clinical Pharmacy, University of Colorado, Skaggs School of Pharmacy and Pharmaceutical Sciences, Anschutz Medical Campus, Aurora, CO, USA.

Essentials Critically ill cancer patients require pharmacologic prophylaxis for venous thromboembolism (VTE). Patients from 566 hospitals in the United States between 2010 and 2014 were included. Low-molecular-weight heparin (LMWH) prophylaxis was not associated in a reduction of VTE rates. Read More

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http://dx.doi.org/10.1111/jth.14317DOI Listing
December 2018
17 Reads

Concurrent mechanical haemolytic anaemia and heparin-induced thrombocytopenia following transcatheter aortic valve replacement.

BMJ Case Rep 2018 Oct 21;2018. Epub 2018 Oct 21.

Department of Pharmacy, Presbyterian Hospital, Albuquerque, New Mexico, USA.

A 78-year-old man with a history of severe aortic stenosis presented with confusion, irregular behaviour and dyspnoea 8 days following transcatheter aortic valve replacement. His exam was consistent with a heart failure exacerbation and he had elevated aminotransferases, bilirubin and prothrombin time suggestive of shock liver. A CT head scan demonstrated a subacute large left temporoparietal infarction. Read More

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http://casereports.bmj.com/lookup/doi/10.1136/bcr-2017-22406
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http://dx.doi.org/10.1136/bcr-2017-224069DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6202965PMC
October 2018
7 Reads

Bivalirudin fails to prevent atrial thrombus development in heparin-induced thrombocytopaenia and thrombosis syndrome.

BMJ Case Rep 2018 Oct 14;2018. Epub 2018 Oct 14.

Division of Cardiology, Albany Medical College, Albany Medical Center, Albany, New York, USA.

An 81-year-old woman presented with acute decompensated heart failure due to new-onset atrial fibrillation and a flail myxomatous mitral valve which necessitated surgical mitral valve repair. No atrial thrombi were noted on transoesophageal echocardiograms performed prior to surgery and intraoperatively. Immediately postoperatively, while treated with unfractionated heparin, the patient developed thrombocytopaenia with positive platelet factor 4 antibodies and an abnormal serotonin functional platelet assay, consistent with heparin-induced thrombocytopaenia. Read More

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http://casereports.bmj.com/lookup/doi/10.1136/bcr-2018-22598
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http://dx.doi.org/10.1136/bcr-2018-225986DOI Listing
October 2018
12 Reads

Cost reduction associated with heparin-induced thrombocytopenia panel ordering for enoxaparin versus heparin for prophylactic and therapeutic use: A retrospective analysis in a community hospital setting.

Avicenna J Med 2018 Oct-Dec;8(4):133-138

Departments of Medicine and Pharmacy, Inspira Health Network, Vineland, New Jersey, USA.

Background: Most hospitals still use unfractionated heparin (UFH) as the primary agent for venous thromboembolism (VTE) prophylaxis in the hospital setting due to ease of use and insignificant cost. However, the risk of heparin-induced thrombocytopenia (HIT) has led some groups to favor other options for therapeutic and prophylactic anticoagulation. This is particularly relevant in light of recent data demonstrating a lower rate of HIT in patients receiving enoxaparin compared with UFH. Read More

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http://www.avicennajmed.com/text.asp?2018/8/4/133/240260
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http://dx.doi.org/10.4103/ajm.AJM_78_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6178568PMC
October 2018
2 Reads

Analyzing the impact of systems-based hematologist in the healthcare system at an academic medical center.

J Thromb Thrombolysis 2018 Oct 13. Epub 2018 Oct 13.

Division of Hematology/Oncology, Department of Medicine, Medical University of South Carolina, 39 Sabin Street, MSC 635, Charleston, SC, 29425, USA.

Over the next decade, there is a predicted shortage of nonmalignant hematologist to maintain the workforce in the United States. To address this, the American Society of Hematology described the creation of the healthcare systems-based hematologist (SBH). The role of SBH has the potential to provide high-value, cost-conscious care to the healthcare system. Read More

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http://link.springer.com/10.1007/s11239-018-1756-5
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http://dx.doi.org/10.1007/s11239-018-1756-5DOI Listing
October 2018
9 Reads

Polyreactive IgM initiates complement activation by PF4/heparin complexes through the classical pathway.

Blood 2018 Dec 11;132(23):2431-2440. Epub 2018 Oct 11.

Division of Hematology, Duke University Medical Center, Durham, NC.

The mechanisms by which exposure to heparin initiates antibody responses in many, if not most, recipients are poorly understood. We recently demonstrated that antigenic platelet factor 4 (PF4)/heparin complexes activate complement in plasma and bind to B cells. Here, we describe how this process is initiated. Read More

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http://www.bloodjournal.org/lookup/doi/10.1182/blood-2018-03
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http://dx.doi.org/10.1182/blood-2018-03-834598DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6284214PMC
December 2018
4 Reads

Rare thrombophilic conditions.

Ann Transl Med 2018 Sep;6(17):342

Section of Clinical Biochemistry, University of Verona, Verona, Italy.

Thrombophilia, either acquired or inherited, can be defined as a predisposition to developing thromboembolic complications. Since the discovery of antithrombin deficiency in the 1965, many other conditions have been described so far, which have then allowed to currently detect an inherited or acquired predisposition in approximately 60-70% of patients with thromboembolic disorders. These prothrombotic risk factors mainly include qualitative or quantitative defects of endogenous coagulation factor inhibitors, increased concentration or function of clotting proteins, defects in the fibrinolytic system, impaired platelet function, and hyperhomocysteinemia. Read More

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http://dx.doi.org/10.21037/atm.2018.08.12DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6174195PMC
September 2018
4 Reads