Heparin Lock Flush

Heparin-induced thrombocytopenia

RN Paul Parks and LNC

heparin-induced thrombocytopenia (HIT) is a severe immune reaction to heparin. Heparin is the anticoagulant most common prescription in the United States. HIT is a potentially fatal disease can lead to amputation and limb loss, it is more common for health care professionals are aware.

Facts on heparin-induced thrombocytopenia, each year 12 million U.S. patients are exposed to the anticoagulant heparin. Contrary to popular belief HIT is not a rare disease as a matter of fact, it occurs in up to 360000-600000 people annually, twice the number of diagnoses of breast cancer in this country each year and nearly equal to the number of new cases of angina are diagnosed each year.

Understanding thrombocytopenia induced by heparin, heparin ironically what is most is used to treat blood clots in the veins and this is where the events occur. venous complications are four times more likely than arterial complications.

Who is at risk of HIT? HIT is the most important reaction of immunological face today. Heparin is used everywhere, for surgery, prophylaxis of clot formation and keeping patent arterial and venous lines is not uncommon to have an intravenous line flushed with heparin so that the tip no occlusion.

The frequency of HIT is related to the type of heparin used. The standard heparin used is unfractionated heparin. If 100 people where treated with unfractionated heparin and having received a full dose 1 / 20 would be to develop HIT. Unfractionated heparin has the most risk. A low molecular weight heparin in HIT produce 1 / 100 patients. Patients exposed to two types of heparin are at risk of HIT.

Concerns Cardiovascular, 100% of patients with coronary artery bypass or open heart surgery al are placed on heparin and that patients with ischemia in the cardiac catheterization laboratory PCI percutaneous coronary intervention. Recent advances in cardiology allow patients to live longer and have less invasive procedures, but some patients with severe disease and still have yet to say angioplasty, stenting and angiography therefore The risk in this patient population is more frequent. All patients admitted to cardiology services is at risk of HIT, but patients most at risk are patients operated due to other causes such as low platelets, blood loss and dilution.

Timing of heparin-induced thrombocytopenia typically occurs between 5 and 14 after starting heparin, the onset may be immediate, and the patient may have a non-eventful hospital stay and get hit at home after output until a week later.

The importance of monitoring platelets, recent studies have shown the best way to identify HIT is a measure of platelet fall, usually in the platelet count decreases to 30-50% of baseline height after surgery down, down 50% of platelets usually means a decrease in platelet count to <150 000 mcl is very characteristic of HIT. More than half of the patients are a low platelet count, the other half will clotting. platelet count falls must be monitored and other processes must be rejected as an infection and after blood dilution device. Physicians must assume patients are HIT while excluding other sources of low platelets.

Make the clinical diagnosis, physicians should try to make the diagnosis before thrombosis occurs. If the patient has deep venous thrombosis with a low platelet count while on heparin HIT diagnosis should be evidence to the contrary. The cornerstone of management is early diagnosis. The best serological tests for HIT SRA test, test HIPA and ELISA tests that have different degrees of reliability. serological tests should not be used to start the treatment of HIT suspects.

The treatment of HIT, the initial goal should be focused on STO.