(精编)【体外膜肺ECMO精品课件】 Heparin-Induced Thrombocytopenia教学课件.pptVIP

Amjad AlMahameed, MD, MPH Diovision of Cardiology Beth Israel Deaconess Medical Center Boston ;Why We Should Not Talk About HIT;12 million patients are exposed to heparin per year;Is it a rare and over publicized disease;THROMBOSIS;;Factors Influencing the Frequency of HIT;No unifying clinical pictureDIFFERENTIATE CLASSICAL HIT FROM ATYPICAL FORMS;Variable Frequency of Reported HIT;;Classical HIT: Thrombocytopenia Criteria; Relative, rather than absolute, thrombocytopenia Platelet count may be normal when patient presents with thrombosis (Delayed onset HIT) In skin necrosis the drop in platelets is small but it may predict arterial thrombosis when it occurs Platelets recovers after heparin withdrawal (Median=4 days) HIT is unlikely when platelets recover despite ongoing heparin therapy;Different Temporal Patterns of Thrombocytopenia in HIT;Very high titers of IgG “super” antibodies to Heparin;Remember Special Cases;Are There Other Forms of Atypical HIT?;Thrombocytopenia in most hospitalized patients is multifactorial in etiology;Non Drug-Induced Thrombocytopenia;Just hold Heparin and It will Go Away!How can we justify anticoagulating thrombocytopenic patients with medications that do not have antidotes?;HIT is a Thrombotic Storm!;HIT = Thrombin GenerationThe Actions of Thrombin;Warkentin and Kelton. Am J Med. 1996;101:502-507.;Just hold Heparin and It will Go Away!How can we justify anticoagulating thrombocytopenic patients with medications that do not have antidotes?;Could not start DTI due to recurrent GI bleed;1 week later;1 week later, L foot;2 weeks later L arm;Decision making when confronting possible HIT;Decision making when confronting possible HIT;Just Switch to LMWH;Necrotic lesion in HIT patient receiving LMWH injections;Skin Necrosis at UFH injection Sites (Prophylactic dose);Necrotic lesions in HIT patient receiving LMWH injections;L arm;This can’t be HIT because the platelet count is not low, (or too low) ;Distribution of Platelet Count in