Heparin-induced thrombocytopenia: recognition, treatment, and prevention: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy.
Research article published in Chest (2004)
Abstract
This chapter about the recognition, treatment, and prevention of heparin-induced thrombocytopenia (HIT) is part of the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy: Evidence Based Guidelines. Grade 1 recommendations are strong and indicate that the benefits do, or do not, outweigh risks, burden, and costs. Grade 2 suggests that individual patients' values may lead to different choices (for a full understanding of the grading, see Guyatt et al, CHEST 2004; 126:179S-187S). Among the key recommendations in this chapter are the following: For patients in whom the risk of HIT is considered to be > 0.1%, we recommend platelet count monitoring (Grade 1C). For patients who are receiving therapeutic-dose unfractionated heparin (UFH), we suggest at least every-other-day platelet count monitoring until day 14, or until UFH is stopped, whichever occurs first (Grade 2C). For patients who are receiving postoperative antithrombotic prophylaxis with UFH (HIT risk > 1%), we suggest at least every-other-day platelet count monitoring between postoperative days 4 to 14 (or until UFH is stopped, whichever occurs first) [Grade 2C]. For medical/obstetric patients who are receiving prophylactic-dose UFH, postoperative patients receiving prophylactic-dose low molecular weight heparin (LMWH), postoperative patients receiving intravascular catheter UFH "flushes," or medical/obstetrical patients receiving LMWH after first receiving UFH (risk, 0.1 to 1%), we suggest platelet count monitoring every 2 days or 3 days from day 4 to day 14, or until heparin is stopped, whichever occurs first (Grade 2C). For medical/obstetrical patients who are only receiving LMWH, or medical patients who are receiving only intravascular catheter UFH flushes (risk < 0.1%), we suggest clinicians do not use routine platelet count monitoring (Grade 2C). For patients with strongly suspected (or confirmed) HIT, whether or not complicated by thrombosis, we recommend use of an alternative anticoagulant, such as lepirudin (Grade 1C+), argatroban (Grade 1C), bivalirudin (Grade 2C), or danaparoid (Grade 1B). For patients with strongly suspected (or confirmed) HIT, we recommend routine ultrasonography of the lower-limb veins for investigation of deep venous thrombosis (Grade 1C); against the use of vitamin K antagonist (VKA) [coumarin] therapy until after the platelet count has substantially recovered; that the VKA antagonist be administered only during overlapping alternative anticoagulation (minimum 5-day overlap); and begun with low, maintenance doses (all Grade 2C). For patients receiving VKAs at the time of diagnosis of HIT, we recommend use of vitamin K (Grade 2C) [corrected] For patients with a history of HIT who are HIT antibody negative and require cardiac surgery, we recommend use of UFH (Grade 1C).
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Zusammenfassung
Heparin-induced thrombocytopenia: recognition, treatment, and prevention: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy.
Warum dies für die Hirudotherapie relevant ist
Diese evidenzbasierte Leitlinie der Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy gibt abgestufte Empfehlungen zur Erkennung, Behandlung und Prävention von HIT. Unter den wesentlichen Empfehlungen erhielt Lepirudin eine Empfehlung Grad 1C+ — die stärkste unter den alternativen Antikoagulanzien — für Patienten mit starkem Verdacht auf oder bestätigter HIT, neben Argatroban (Grad 1C), Bivalirudin (Grad 2C) und Danaparoid (Grad 1B); weitere Empfehlungen betreffen Schemata zur Thrombozytenzahl-Überwachung, routinemäßige Ultraschalluntersuchungen der unteren Extremitäten und das Management von Vitamin-K-Antagonisten. Diese Leitlinie ist für den ASH-Bereich relevant, da sie Lepirudin, ein rekombinantes aus Blutegeln stammendes Antikoagulans, formal als Erstlinientherapieoption für eine schwerwiegende iatrogene Erkrankung anerkennt. Die Leitlinie befasst sich jedoch mit dem Management pharmazeutischer Antikoagulation und nicht mit der Therapie lebender Blutegel, und Lepirudin ist eine von mehreren empfohlenen Alternativen.
Zitation
Heparin-induced thrombocytopenia: recognition, treatment, and prevention: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy.
Warkentin et al. · Chest, 2004
Verwandter klinischer Kontext
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