Is it hit or hat
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IS IT HIT OR HAT?. M&M Conference 3/28/02. HAT. Mild thrombocythopenia 100K- 130K Incidence: 25% 1-4 days after starting heparin Non immune-mediated (direct interaction between Heparin and platelet) Non thrombogenic Thrombocythopenia resolves after heparin discontinuation. HIT.

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IS IT HIT OR HAT?

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Is it hit or hat

IS IT HIT OR HAT?

M&M Conference 3/28/02


Is it hit or hat

HAT

  • Mild thrombocythopenia 100K- 130K

  • Incidence: 25%

  • 1-4 days after starting heparin

  • Non immune-mediated (direct interaction between Heparin and platelet)

  • Non thrombogenic

  • Thrombocythopenia resolves after heparin discontinuation


Is it hit or hat

HIT

  • Un expected drop in platelet count

    • Less than 100,000

    • And about 50% of base line

  • Incidence: 1% to 3% on UFH

  • On Heparin for at least 5 days OR

  • Was on Heparin the last 3 months

  • More with UFH than with LMWH

  • Patient are at high risk of clothing NOT bleeding!


Pathophysiology

Pathophysiology

  • Heparin has an affinity to PF4 which is found in platelet  granules

  • Heparin-PF4 compleax induce IgG reaction

  • IgG-heparin-PF4 complex attaches to platelet leading to aggregation (cloth)

    more PF4 production and so on

  • 80% cross reactivity with LMWH


Clinical manifestation

Clinical manifestation

  • HITTS in 25%

  • VTE > ATE (4X)

    • ATE

      • Stroke. & Limb, bowel, splenic infarction

    • VTE

      • DVT & PE

  • Acute HIT fever, N/V, chest pain

  • Sub acute asymptomatic

  • Delayed: accumulative risk of developing a cloth is 50% in one month


Diagnosis

Diagnosis

  • Clinical!

  • Lab tests


Treatment

Treatment

  • All sources of heparin should be discontinued

  • D/C H2 blockers, quinines and reassess the need for Abx

  • HIT:

    • Danaparoid

    • Lepirudin or Bivalirudin

    • DON’T use warfarin Or LMWH


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