HIT (Heparin-Induced Thrombocytopenia) Form


HIT Algorithm:

Full anticoagulation with argatroban / lepirudin until platelet count rises above 150,000/uL

ARGATROBAN

– synthetic analogue of L-arginine

-reversibly binds active site of thrombin

– rapid onset, given by drip

– goal is PTT 1.5-3x control

– cleared by liver

– ok to use in renal insufficiency (no dose adjustment)

LEPIRUDIN

– recombinant form of hirudin (anticoagulant in leech saliva), binds irreversibly to thrombin

– given as drip

– give bolus i life-threatening thrombosis

– goal: PTT 1.5-3x control

– cleared by kidneys.

– re-exposure can produce life-threatening anaphylaxis: ONE TIME TREATMENT ONLY

COUMADIN

Start coumadin for long-term anticoagulation if HIT associated with thrombosis.

Do not start coumadin until platelet count increases >150,000/uL.

Initial dose of coumadin should not exceed 5mg. (Reduce risk of limb gangrene during active phase of HIT)

Continue antithrombin agents until coumadin achieves full anticoagulation

REFERENCE:

Kiwon Lee NeuroICU Book.

(Marino, 2014)

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