Sandbox 19: Difference between revisions
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==Treatment of HIT== | |||
{{familytree/start}} | |||
{{familytree | | | | A01 | | | | A01= <div style="height: 1em; width: 25em; padding:0.5em;">'''High suspicion or confirmed [[HIT]]''' </div>}} | |||
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| | {{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>}} | ||
| | {{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>}} | ||
{{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>}} | ||
{{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>}} | ||
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|- | {{familytree | | | | F01 | | | | F01= <div style="height: 2em; width: 25em; padding:0.5em;">❑ Check if patient is/needs to be on VKA </div>}} | ||
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|- | {{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>}} | ||
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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] | |||||||||||||||||||
- ↑ 1.0 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.
- ↑ 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.