3,769 results match your criteria Heparin-Induced Thrombocytopenia


Routine monitoring for heparin-induced thrombocytopenia following lower limb arthroplasty: Is it necessary? A prospective study in a UK district general hospital.

Orthop Traumatol Surg Res 2019 Mar 13. Epub 2019 Mar 13.

York Hospital NHS Foundation Trust, Wiggington Road, York, YO31 8HE, United Kingdom.

Introduction: Heparin-induced thrombocytopenia (HIT) is a potentially life-threatening condition associated with heparin administration. Many orthopaedic units routinely prescribe low-molecular-weight heparins as thromboprophylaxis after hip and knee arthroplasty.

Hypothesis: We postulated that routine platelet monitoring following heparin administration is of no clinical benefit. Read More

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http://dx.doi.org/10.1016/j.otsr.2018.12.012DOI Listing

Management of Anticoagulation with Impella® Percutaneous Ventricular Assist Devices and Review of New Literature.

J Thromb Thrombolysis 2019 Mar 15. Epub 2019 Mar 15.

Department of Pharmacy, Houston Methodist Hospital, Houston, TX, USA.

Cardiogenic shock is a life-threatening condition that may occur secondary to a variety of cardiac conditions, and may require temporary support with percutaneous ventricular devices like the Impella®. Anticoagulation in patients with Impella® devices can often be complicated due to unpredictable purge flow rates, pre-existing coagulopathy, or heparin allergies. The purpose of this article is to discuss the various options for anticoagulation in the setting of Impella®. Read More

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http://dx.doi.org/10.1007/s11239-019-01837-6DOI Listing
March 2019
1 Read

Heparin-induced thrombocytopenia during extracorporeal life support: incidence, management and outcomes.

Ann Cardiothorac Surg 2019 Jan;8(1):19-31

Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, PA, USA.

Background: Heparin-induced thrombocytopenia (HIT) is a severe antibody-mediated reaction leading to transient prothrombosis. However, its incidence in patients on extracorporeal life support (ECLS) is not well described. The aim of this systematic review was to report the incidence of HIT in patients on ECLS, as well as compare the characteristics and outcomes of HIT in patients undergoing veno-arterial extracorporeal membrane oxygenation (VA-ECMO) and veno-venous ECMO (VV-ECMO). Read More

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http://dx.doi.org/10.21037/acs.2018.12.02DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6379191PMC
January 2019
2 Reads

Autoimmune Heparin-Induced Thrombocytopenia: Treatment Obstacles and Challenging Length of Stay.

Am J Case Rep 2019 Mar 9;20:310-313. Epub 2019 Mar 9.

Division of Hematology and Medical Oncology, Brookdale University Hospital, Brooklyn, NY, USA.

BACKGROUND Autoimmune heparin-induced thrombocytopenia (aHIT) refers to a condition, in which antiplatelet factor-4 (PF4) antibodies activate platelets even in the absence of heparin (heparin independent platelet activation). This is a severe hypercoagulable state triggering massive thrombin storm needing additional therapies and aggressive anticoagulation apart from stopping heparin. Thrombocytopenia in these cases seems to be very severe and prolonged compared to classic HIT and poses additional clinical challenges in terms of anticoagulation management. Read More

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http://dx.doi.org/10.12659/AJCR.914575DOI Listing
March 2019
2 Reads

Venous thromboembolism and cancer: Current and future role of direct-acting oral anticoagulants.

Thromb Res 2019 Feb 27;177:33-41. Epub 2019 Feb 27.

Internal and Cardiovascular Medicine - Stroke Unit, University of Perugia, Italy.

Approximately one-fifth of all cases of venous thromboembolism (VTE) are related to cancer and anticoagulant treatment in these patients has remained a challenge. Cancer patients with VTE are at increased risk of developing recurrent VTE compared to patients without cancer, but also have a higher risk of major bleeding. In these patients, low molecular weight heparins (LMWHs) have been shown to be more effective and as safe as vitamin K-antagonists (VKAs) for the treatment of VTE. Read More

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http://dx.doi.org/10.1016/j.thromres.2019.02.031DOI Listing
February 2019
1 Read

Evaluation of STic Expert HIT Kit and Its Comparison with ID-PaGIA™ Test in Suspected Heparin-Induced Thrombocytopenia.

Indian J Hematol Blood Transfus 2019 Jan 1;35(1):155-160. Epub 2018 Aug 1.

3Department of Transfusion Medicine, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012 India.

Heparin-induced thrombocytopenia (HIT) is an adverse drug reaction caused by heparin. HIT occurs due to IgG antibodies directed against heparin-bound platelet factor 4 (PF4). The aim of this study was to evaluate the STic Expert HIT for detection of anti-PF4/heparin antibodies in comparison with ID-PaGIA™ kit. Read More

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http://dx.doi.org/10.1007/s12288-018-0996-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6369102PMC
January 2019
1 Read
0.234 Impact Factor

Converting the Distinct Heparins Sourced from Bovine or Porcine Mucosa into a Single Anticoagulant Drug.

Thromb Haemost 2019 Apr 21;119(4):618-632. Epub 2019 Feb 21.

Institute of Medical Biochemistry Leopoldo de Meis, Universitary Hospital Clementino Fraga Filho, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.

Unfractionated heparin (UFH) and their low-molecular-weight derivatives are sourced almost exclusively from porcine mucosa (HPI); however, a worldwide introduction of UFH from bovine mucosa (HBI) has been recommended to reinforce the currently unsteady supply chain of heparin products. Although HBI has different chemical composition and about half of the anticoagulant potency of HPI (∼100 and ∼180 international unit [IU]/mg, respectively), they have been employed as interchangeable UFHs in some countries since the 1990s. However, their use as a single drug provoked several bleeding incidents in Brazil, which precipitated the publication of the first monographs exclusive for HBI and HPI by the Brazilian Pharmacopoeia. Read More

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http://www.thieme-connect.de/DOI/DOI?10.1055/s-0039-1678663
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http://dx.doi.org/10.1055/s-0039-1678663DOI Listing
April 2019
4 Reads

Development of an algorithm for the systematic evaluation of patients with suspected heparin-induced thrombocytopenia.

J Thromb Thrombolysis 2019 Feb 21. Epub 2019 Feb 21.

Pharmacy Department, Henry Ford Hospital, Detroit, MI, USA.

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http://dx.doi.org/10.1007/s11239-019-01828-7DOI Listing
February 2019

Nattokinase-heparin exhibits beneficial efficacy and safety-an optimal strategy for CKD patients on hemodialysis.

Glycoconj J 2019 Feb 20. Epub 2019 Feb 20.

Wuya College of Innovation, Shenyang Pharmaceutical University, Shenyang, Liaoning, 110016, People's Republic of China.

Heparin is a widely used anticoagulant in hemodialysis (HD) for patients with chronic kidney disease (CKD); however, it entails the risk of thrombus formation due to heparin-induced thrombocytopenia. Indeed, CKD patients on HD are associated with excessive mortality from cardiovascular disease due to their prothrombotic profile. Therefore, it would be a significant breakthrough to develop a thrombolytic adjuvant that facilitates heparin to achieve its proper anticoagulant efficiency at a much lower dose for greater safety. Read More

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http://dx.doi.org/10.1007/s10719-019-09860-8DOI Listing
February 2019
1 Read
2.520 Impact Factor

Successful Management of Late-Onset Cytomegalovirus-Induced Hemophagocytic Lymphohistiocytosis in Kidney Transplant Recipient After Coronary Artery Bypass Graft Surgery.

Exp Clin Transplant 2019 01;17(Suppl 1):207-211

From the Nephrology Department, Hamd Al-Essa Organ Transplant Center of Kuwait, Kuwait.

Hemophagocytic syndrome combines febrile hepatosplenomegaly, pancytopenia, hypofibrinemia, and hepatic dysfunction. It is characterized by bone marrow and organ infiltration of activated, nonmalignant macrophages that phagocytize blood cells. It is rare among renal transplant recipients. Read More

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http://dx.doi.org/10.6002/ect.MESOT2018.P67DOI Listing
January 2019
1 Read

High-dose intravenous immunoglobulin to treat spontaneous heparin-induced thrombocytopenia syndrome.

J Thromb Haemost 2019 Feb 18. Epub 2019 Feb 18.

Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada.

Essentials Spontaneous HIT syndrome clinically/serologically resembles HIT but without proximate heparin. Rarely, spontaneous HIT syndrome complicates total knee arthroplasty surgery. Mesenteric vein thrombosis is a rare presentation of spontaneous HIT syndrome. Read More

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http://dx.doi.org/10.1111/jth.14411DOI Listing
February 2019
4 Reads

Heparin-Induced Thrombocytopenia: Finding the Needle in the Haystack.

Crit Care Med 2019 Mar;47(3):474-475

Department of Critical Care, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.

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http://dx.doi.org/10.1097/CCM.0000000000003603DOI Listing

[Heparin-induced thrombotic thrombocytopenia: An uncommon potentially serious entity].

Aten Primaria 2019 Feb 5. Epub 2019 Feb 5.

Servicio de Dermatología, Hospital Clínic de Barcelona, Barcelona, España. Electronic address:

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http://dx.doi.org/10.1016/j.aprim.2018.10.005DOI Listing
February 2019

False-Negative Platelet Factor 4 Antibodies and Serotonin Release Assay and the Utility of Repeat Testing in the Diagnosis of Heparin-Induced Thrombocytopenia and Thrombosis.

Case Rep Hematol 2019 8;2019:1585014. Epub 2019 Jan 8.

Department of Neurointensive Care, Cerebrovascular Center, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio 44195, USA.

Objective: To report a case of false-negative serological tests in the diagnosis of heparin-induced thrombocytopenia (HIT) followed by a brief review of the literature on this topic.

Case Presentation: A 75-year-old Caucasian female patient was admitted with a traumatic right ankle fracture that required open reduction and internal fixation. Despite postoperative subcutaneous heparin chemoprophylaxis, she developed deep vein thrombosis (DVT) and pulmonary embolism (PE) on day 4 and subsequently started on continuous heparin infusion. Read More

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http://dx.doi.org/10.1155/2019/1585014DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6341253PMC
January 2019
2 Reads

A multicentre controlled pre-post trial of an implementation science intervention to improve venous thromboembolism prophylaxis in critically ill patients.

Intensive Care Med 2019 Feb 1;45(2):211-222. Epub 2019 Feb 1.

Department of Critical Care Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, T2N 4Z6, Canada.

Purpose: To test whether a multicomponent intervention would increase the use of low molecular weight heparin (LMWH) over unfractionated heparin (UFH) for venous thromboembolism (VTE) prophylaxis in critically ill patients and change patient outcomes and healthcare utilization.

Methods: Controlled pre-post trial of 12,342 adults admitted to 11 ICUs (five intervention, six control) May 1, 2015 to April 30, 2017 with no contraindication to pharmacological prophylaxis and an ICU stay longer than 24 h. Models were developed to examine temporal changes in ICU VTE prophylaxis (primary outcome), VTE, major bleeding, heparin-induced thrombocytopenia (HIT), death and hospital costs. Read More

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http://dx.doi.org/10.1007/s00134-019-05532-1DOI Listing
February 2019
1 Read

Diagnostics of thrombocytopenias.

Ter Arkh 2018 Aug;90(7):4-13

National Medical Research Center for Hematology Russian Ministry of Health, Moscow, Russia.

Laboratory methods used for the diagnostics of thrombocytopenias are reviewed. Differential diagnosis is usually carried out between immune and hypoproductive forms of thrombocytopenia. Immune thrombocytopenias are caused by appearance in blood of antiplatelet abtibodies and accelerated destruction of platelets sensibilized by those antibodies, and hypoproductive thrombocytopenias - by impaired platelet production in the bone marrow. Read More

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http://dx.doi.org/10.26442/terarkh20189074-13DOI Listing

A platelet viability assay (PVA) for the diagnosis of heparin-induced thrombocytopenia.

Platelets 2019 Jan 29:1-5. Epub 2019 Jan 29.

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

Diagnosing heparin-induced thrombocytopenia (HIT) requires functional assays measuring platelet activation as they are highly specific and sensitive. A useful functional test for diagnosing HIT is the serotonin release assay (SRA), but this assay is technically demanding and requires a radioactive marker. We describe an alternate functional HIT assay, the platelet viability assay (PVA), that overcomes the need for a radioactive marker by using a viability dye endpoint to measure platelet activation. Read More

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http://dx.doi.org/10.1080/09537104.2018.1562169DOI Listing
January 2019
2 Reads

Successful Use of Cangrelor and Heparin for Cardiopulmonary Bypass in a Patient With Heparin-Induced Thrombocytopenia and End-Stage Renal Disease: A Case Report.

A A Pract 2019 Jan 25. Epub 2019 Jan 25.

From the Departments of Anesthesiology.

Heparin is the only well-established anticoagulant medication for cardiopulmonary bypass making selecting an alternative anticoagulant challenging in patients with heparin-induced thrombocytopenia. Other anticoagulant medications can cause significant postoperative bleeding, especially in patients with end-stage renal disease. We present a case of a 63-year-old woman requiring aortic valve replacement with a history of heparin-induced thrombocytopenia and end-stage renal disease. Read More

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http://dx.doi.org/10.1213/XAA.0000000000000969DOI Listing
January 2019
1 Read

Fondaparinux in heparin-induced thrombocytopenia: A decade's worth of clinical experience.

Authors:
Marc Schindewolf

Res Pract Thromb Haemost 2019 Jan 4;3(1):9-11. Epub 2018 Dec 4.

Swiss Cardiovascular Center Division of Vascular Medicine University Hospital Bern Bern Switzerland.

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http://dx.doi.org/10.1002/rth2.12169DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6332747PMC
January 2019

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
1 Read

An international external quality assessment for laboratory diagnosis of heparin-induced thrombocytopenia.

J Thromb Haemost 2019 Mar 20;17(3):525-531. Epub 2019 Feb 20.

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

Essentials A pilot study for External Quality Assessment for testing of HIT is described. The qualitative accordance for the PF4/heparin IgG test was 97.6%. Read More

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http://dx.doi.org/10.1111/jth.14383DOI Listing
March 2019
3 Reads

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
15 Reads

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
3 Reads

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

J Thromb Thrombolysis 2019 Feb;47(2):287-291

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
February 2019
1 Read

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
5 Reads
1.083 Impact Factor

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

J Thromb Haemost 2019 Feb;17(2):389-399

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

Essentials Many patients produce antibodies but few lead to heparin-induced thrombocytopenia (HIT). Pathogenic epitopes are difficult to identify as HIT antibodies are polyclonal and polyspecific. KKO binding to platelet factor 4 (PF4) depends on 13 amino acids, three of which are newly observed. Read More

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http://dx.doi.org/10.1111/jth.14369DOI Listing
February 2019
2 Reads

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

Blood 2019 Feb 20;133(9):978-989. Epub 2018 Dec 20.

Institut für Immunologie und Transfusionsmedizin and.

Heparin-induced thrombocytopenia (HIT) is caused by platelet-activating anti-platelet factor 4 (PF4)/heparin antibodies. Platelet activation assays that use "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 the risk of PF4/heparin immunization and, among antibody-positive patients, the 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
February 2019
10 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
2 Reads

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
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6320049PMC
December 2018
1 Read
5.723 Impact Factor

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

Transfusion 2019 Mar 17;59(3):931-934. 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
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6402961PMC
March 2019
3 Reads

A computerized scoring system to improve assessment of heparin-induced thrombocytopenia risk.

J Thromb Haemost 2019 Feb 22;17(2):383-388. Epub 2019 Jan 22.

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

Essentials Current risk scores for heparin-induced thrombocytopenia (HIT) are not computer-friendly. We compared a new computerized risk score with the 4Ts score in a large healthcare system. The computerized risk score agrees with the 4Ts score 85% of the time. Read More

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http://dx.doi.org/10.1111/jth.14359DOI Listing
February 2019

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

J Pediatr Hematol Oncol 2019 Mar;41(2):81-86

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
March 2019
2 Reads

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
12 Reads
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
Publisher Site
http://dx.doi.org/10.1093/ejcts/ezy411DOI Listing
December 2018
3 Reads

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
4 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
3 Reads

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
3 Reads

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
27 Reads
3.225 Impact Factor

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

Crit Care Med 2019 Mar;47(3):353-359

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
March 2019
2 Reads

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
7 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
2 Reads

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
4 Reads

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
3 Reads

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
62 Reads

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

J Thromb Thrombolysis 2019 Jan;47(1):155-156

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
January 2019
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
2 Reads

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
2 Reads