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IS IT HIT OR HAT?

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?

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  1. IS IT HIT OR HAT? M&M Conference 3/28/02

  2. 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

  3. 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!

  4. 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

  5. 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

  6. Diagnosis • Clinical! • Lab tests

  7. 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

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