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{| class="wikitable sortable"
==Treatment of HIT==
! Specialty
 
! Topic
{{familytree/start}}
! Author
{{familytree | | | | A01 | | | | A01= <div style="height: 1em; width: 25em; padding:0.5em;">'''High suspicion or confirmed [[HIT]]''' </div>}}
! Status
{{familytree | |,|-|-|^|-|-|.| | }}
|-
{{familytree | B01 | | | | B02 | B01= <div style="height: 1em; width: 15em; padding:0.5em;">'''HIT with thrombosis'''</div>| B02= <div style="height: 1em; width: 15em; padding:0.5em;">'''Isolated HIT'''</div>}}
| Cardiology || Acute coronary syndrome ||||
{{familytree | |!| | | | | |!| | }}
|-
{{familytree | |!| | | | | C03 | C03= <div style="height: 3em; width: 15em; padding:0.5em;">❑ Perform a lower extremity U/S to R/O asymptomatic DVT<ref name="pmid22246036">{{cite journal| author=Cuker A, Cines DB| title=How I treat heparin-induced thrombocytopenia. | journal=Blood | year= 2012 | volume= 119 | issue= 10 | pages= 2209-18 | pmid=22246036 | doi=10.1182/blood-2011-11-376293 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22246036  }} </ref></div>}}
| Cardiology || Acute decompensated heart failure ||||
{{familytree | |!| |,|-|-|-|(| | }}
|-
{{familytree | |!| D01 | | D02 | D01= <div style="height: 2em; width: 15em; padding:0.5em;">'''Presence of asymptomatic DVT'''</div>| D02= <div style="height: 2em; width: 15em; padding:0.5em;">'''No DVT''' </div>}}
| Cardiology || Arrhythmia ||||
{{familytree | |!|!| | | | |!| | }}
|-
{{familytree | E01 | | | | E02 | E01= <div style="float: left; text-align: left; height: 12em; width: 15em; padding:0.5em;">❑ Discontinue heparin <br> ❑ Initiate non heparin anticoagulation for '''3-6 months''':<br>- [[Argatroban]] (can be used in renal insufficiency)<br>- [[Lepirudin]] <br>- [[Danaparoid]]<ref name="pmid22246036">{{cite journal| author=Cuker A, Cines DB| title=How I treat heparin-induced thrombocytopenia. | journal=Blood | year= 2012 | volume= 119 | issue= 10 | pages= 2209-18 | pmid=22246036 | doi=10.1182/blood-2011-11-376293 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22246036  }} </ref></div>| E02= <div style="float: left; text-align: left; height: 12em; width: 15em; padding:0.5em;">❑ Discontinue heparin <br>❑ Initiate non heparin anticoagulation until platelets are back to normal:<ref name="pmid22246036">{{cite journal| author=Cuker A, Cines DB| title=How I treat heparin-induced thrombocytopenia. | journal=Blood | year= 2012 | volume= 119 | issue= 10 | pages= 2209-18 | pmid=22246036 | doi=10.1182/blood-2011-11-376293 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22246036  }} </ref><br>- [[Argatroban]] (can be used in renal insufficiency)<br>- [[Lepirudin]] <br>- [[Danaparoid]]</div>}}
| Cardiology || Atrial fibrillation ||||
{{familytree | |`|-|-|v|-|-|'| | }}
|-
{{familytree | | | | F01 | | | | F01= <div style="height: 2em; width: 25em; padding:0.5em;">❑ Check if patient is/needs to be on VKA </div>}}
| Cardiology || Atrial flutter ||||
{{familytree | | | | |!| | | | | }}
|-
{{familytree | | | | G01 | | | | G01= <div style="float: left; text-align: left; height: 10em; width: 25em; padding:0.5em;">❑ Don't start VKA until the platelet count goes back to normal, after which initiate VKA at low doses <br>❑ When VKA is to be started, overlap it with non heparin anticoagulant for at least 5 days until INR is within the target range<br>❑ If VKAis started when patient is diagnosed with HIT, administer vitamin K<ref name="pmid22315270">{{cite journal| author=Linkins LA, Dans AL, Moores LK, Bona R, Davidson BL, Schulman S et al.| title=Treatment and prevention of heparin-induced thrombocytopenia: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. | journal=Chest | year= 2012 | volume= 141 | issue= 2 Suppl | pages= e495S-530S | pmid=22315270 | doi=10.1378/chest.11-2303 | pmc=PMC3278058 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22315270  }} </ref></div>}}
| Cardiology || Bradycardia ||||
{{familytree/end}}
|-
| Cardiology || Cardiac arrest ||||
|-
| Cardiology || Cardiogenic failure ||||
|-
| Cardiology || Chest pain ||||
|-
| Cardiology || Constrictive pericarditis ||||
|-
| Cardiology || Hypertension ||||
|-
| Cardiology || Hypertensive crisis ||||
|-
| Cardiology || Narrow complex tachycardia ||||
|-
| Cardiology || Pericardial tamponade ||||
|-
| Cardiology || Pericarditis ||||
|-
| Cardiology || Syncope ||||
|-
| Cardiology || Wide complex tachycardia ||||
|-
| Pulmonary || Acute respiratory distress syndrome ||||
|-
| Pulmonary || Anaphylaxis ||||
|-
| Pulmonary || Asthma exacerbation ||||
|-
| Pulmonary || COPD exacerbation ||||
|-
| Pulmonary || Deep venous thrombosis ||||
|-
| Pulmonary || Dyspnea ||||
|-
| Pulmonary || Hemoptysis ||||
|-
| Pulmonary || Mechanical ventilation ||||
|-
| Pulmonary || Pleural effusion ||||
|-
| Pulmonary || Pulmonary embolism ||||
|-
| Pulmonary || Pulmonary hypertension ||||
|-
| Pulmonary || Respiratory failure ||||
|-
| Gastroenterology || Abdominal pain ||||
|-
| Gastroenterology || Abnormal liver tests ||||
|-
| Gastroenterology || Acetaminophen toxicity ||||
|-
| Gastroenterology || Acute diarrhea ||||
|-
| Gastroenterology || Acute liver failure ||||
|-
| Gastroenterology || Acute pancreatitis ||||
|-
| Gastroenterology || Ascites ||||
|-
| Gastroenterology || Biliary tract diseases ||||
|-
| Gastroenterology || Chronic diarrhea ||||
|-
| Gastroenterology || Clostridium difficile associated diarrhea ||||
|-
| Gastroenterology || Constipation ||||
|-
| Gastroenterology || Crohn’s disease ||||
|-
| Gastroenterology || Ileus ||||
|-
| Gastroenterology || Intestinal ischemia ||||
|-
| Gastroenterology || Lower gastrointestinal bleeding ||||
|-
| Gastroenterology || Nutrition ||||
|-
| Gastroenterology || Ulcerative colitis ||||
|-
| Gastroenterology || Upper gastrointestinal bleeding ||||
|-
| Nephrology || Acidosis ||||
|-
| Nephrology || Acute kidney injury ||||
|-
| Nephrology || Alkalosis ||||
|-
| Nephrology || Hyperkalemia ||||
|-
| Nephrology || Hypernatremia ||||
|-
| Nephrology || Hypokalemia ||||
|-
| Nephrology || Hyponatremia ||||
|-
| Nephrology || Metabolic acidosis ||||
|-
| Nephrology || Metabolic alkalosis ||||
|-
| Nephrology || Nephrolithiasis ||||
|-
| Nephrology || Polyuria ||||
|-
| Nephrology || Respiratory acidosis ||||
|-
| Nephrology || Respiratory alkalosis ||||
|-
| Hematology-Oncology || Anemia ||||
|-
| Hematology-Oncology || Hemolytic anemia ||||
|-
| Hematology-Oncology || Pancytopenia ||||
|-
| Hematology-Oncology || Bleeding disorders ||||
|-
| Hematology-Oncology || Thrombocytopenia ||||
|-
| Hematology-Oncology || DIC ||||
|-
| Hematology-Oncology || Transfusion therapy ||||
|-
| Hematology-Oncology || Breast cancer screening ||||
|-
| Hematology-Oncology || Febrile neutropenia ||||
|-
| Hematology-Oncology || Tumor lysis syndrome ||||
|-
| Infectious Diseases || Pneumonia ||||
|-
| Infectious Diseases || Urinary tract infection ||||
|-
| Infectious Diseases || Cellulitis ||||
|-
| Infectious Diseases || Diabetic foot ||||
|-
| Infectious Diseases || Acute bacterial meningitis ||||
|-
| Infectious Diseases || Endocarditis ||||
|-
| Infectious Diseases || Fever of unknown origin ||||
|-
| Infectious Diseases || Fever and rash ||||
|-
| Infectious Diseases || Fever after travel ||||
|-
| Infectious Diseases || Sepsis ||||
|-
| Endocrinology || Hypercalcemia ||||
|-
| Endocrinology || Hypocalcemia ||||
|-
| Endocrinology || Diabetic ketoacidosis ||||
|-
| Endocrinology || Hyperosmolar hyperglycemic state ||||
|-
| Neurology || Change in Mental Status ||||
|-
| Neurology || Status epilepticus ||||
|-
| Neurology || Alcohol withdrawal ||||
|-
| Neurology || Stroke ||||
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| Neurology || Headache ||||
|-
| Neurology || Back pain ||||
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| Miscellaneous || ICU Medications ||||
|-
| Miscellaneous || Pulmonary edema, hypotension and shock ||||
|-
| Miscellaneous || Anticoagulation therapy ||||
|}

Latest revision as of 15:10, 2 January 2014

Treatment of HIT

 
 
 
High suspicion or confirmed HIT
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
HIT with thrombosis
 
 
 
Isolated HIT
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
❑ Perform a lower extremity U/S to R/O asymptomatic DVT[1]
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Presence of asymptomatic DVT
 
No DVT
 
 
 
 
 
 
 
 
 
 
 
 
 
❑ Discontinue heparin
❑ Initiate non heparin anticoagulation for 3-6 months:
- Argatroban (can be used in renal insufficiency)
- Lepirudin
- Danaparoid[1]
 
 
 
❑ Discontinue heparin
❑ Initiate non heparin anticoagulation until platelets are back to normal:[1]
- Argatroban (can be used in renal insufficiency)
- Lepirudin
- Danaparoid
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
❑ Check if patient is/needs to be on VKA
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
❑ Don't start VKA until the platelet count goes back to normal, after which initiate VKA at low doses
❑ When VKA is to be started, overlap it with non heparin anticoagulant for at least 5 days until INR is within the target range
❑ If VKAis started when patient is diagnosed with HIT, administer vitamin K[2]
 
 
 
  1. ↑ 1.0 1.1 1.2 Cuker A, Cines DB (2012). "How I treat heparin-induced thrombocytopenia". Blood. 119 (10): 2209–18. doi:10.1182/blood-2011-11-376293. PMID 22246036.
  2. ↑ Linkins LA, Dans AL, Moores LK, Bona R, Davidson BL, Schulman S; et al. (2012). "Treatment and prevention of heparin-induced thrombocytopenia: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines". Chest. 141 (2 Suppl): e495S–530S. doi:10.1378/chest.11-2303. PMC 3278058. PMID 22315270.
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