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heparininducedthrombocytopeniauniversityofheparininduced血小板减少大学.pptx

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HEPARIN-INDUCED THROMBOCYTOPENIA;HEPARIN-INDUCED THROMBOCYTOPENIA;HEPARIN-INDUCED THROMBOCYTOPENIA;HEPARIN-INDUCED THROMBOCYTOPENIA;THROMBOTIC COMPLICATIONS IN HIT;ISOLATED HIT IS ASSOCIATED WITH A HIGH RISK OF SUBSEQUENT THROMBOSIS;UNFRACTIONATED HEPARIN IS MORE LIKELY TO CAUSE HIT THAN LMWH;Warkentin et al, NEJM 1995;332:1330;;LMWH IS MORE LIKELY TO CAUSE HIT IN PATIENTS WITH PRIOR UFH EXPOSUREPrandoni et al, Blood 2005;106:3049;Development of HIT antibodies is more common in major surgery than minor surgery, and more common with UFH than LMWHResults of a prospective trial;Warkentin et al, NEJM 1995;332:1330;*;Recent heparin exposure may cause “rapid onset” HIT;Rapid-onset HIT is associated with re-exposure to heparin within 90 days;Heparin-dependent antibodies usually disappear within 90 days an episode of HIT;DELAYED ONSET HIT;PATHOPHYSIOLOGY OF HIT;HIT IS CAUSED BY ANTIBODIES AGAINST A HEPARIN-PLATELET FACTOR 4 COMPLEX;PATHOPHYSIOLOGY OF HIT;Heparin concentration affects the size and charge of heparin:PF4 complexes and their ability to activate platelets;Clinical factors may help determine the likelihood of developing HIT;HIT Antibodies can activate platelets in the absence of heparin;DIAGNOSIS OF HIT;DISTINGUISHING IMMUNE FROM NON-IMMUNE HEPARIN INDUCED THROMBOCYTOPENIA;Median platelet nadir 55K 15% had nadir 150K (diagnosed because platelet count fell more than 50% or because of clinical events) The severity of thrombocytopenia did not predict thrombotic events;Clincal features that favor a diagnosis of HIT;The 4 T score predicts a positive HIT antibody testJ Thrombos Haemost 2006;4:759;LABORATORY DIAGNOSIS OF HIT;The serotonin release assay predicts thrombosis in HIT;Warkentin, Brit J Haematol 2003;121:535;J Thrombos Haemost 2004;2:2133-7;TREATMENT OF HIT;TREATMENT OF HIT;DIRECT THROMBIN INHIBITORS;LEPIRUDIN PROPHYLAXIS IN HITBlood 2004;104:3072;LEPIRUDIN IN HITHAT-3 trial (HIT with or without concurrent thrombosis);The risk of bleeding with lepirudin