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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

IS IT HIT OR HAT?

M&M Conference 3/28/02

slide2
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
slide3
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