The Perioperative Management of Heparin Induced Thrombocytopenia. Chaitan K. Narsule, M.D. March 5, 2008
|
|
- Milton Hodges
- 5 years ago
- Views:
Transcription
1 The Perioperative Management of Heparin Induced Thrombocytopenia Chaitan K. Narsule, M.D. March 5, 2008
2 Overview Case Presentation Incidence of HIT Pathophysiology Clinical Presentation Laboratory Diagnosis Treatment Prevention Perioperative Considerations
3 Case Presentation
4 Case Presentation 48 year old man with extensive hx of rheumatoid arthritis Had contracture of left foot Underwent orthopaedic procedures* for left foot contracture Two weeks later, presented to ED with cold, pulseless left leg *arthrodesis, Achilles tendon lengthening, and talar exostectomy
5 Laboratory Data PT = 13.9 INR = 1.3 aptt = 46.7 Lactic acid = 1.6.
6
7
8
9 Case Presentation HIT was presumed. Argatroban was started. Patient underwent iliofemoral thrombectomy and left leg fasciotomies
10 Case Presentation Over one week later, developed severe abdominal pain, distension, and fever. Had an elevated WBC, platelet count of 12k, and was still on Argatroban. CT scan of the abdomen
11
12 What do you do now? or.
13 Incidence of HIT
14 At-Risk Populations for HIT Post-op patients Orthopaedic patients Cardiac/Vascular/General surgical patients Obstetric patients Medical patients
15 Arepally et al. NEJM ;8:
16 Gender Imbalance and HIT Warkentin et al. Blood 2006;108:
17 Pathophysiology
18 Ahmed et al. Postgrad Med J 2007;83:
19 Pathophysiology Abs recognize heparin induced conformational change in PF4 molecule Keeling et al. Br J Haem 2006;133:
20 Type I Type I vs. Type II HIT Asymptomatic, mild decrease in platelet count (usually >100 x 10 9 /L) Incidence ~10-20% of all patients on heparin. Non-immunogenic response to heparin. Platelets recover even with continuation of heparin. Menajovsky. Am J Med 2005;118:21s-30s
21 Clinical Presentation
22 The Vernacular of HIT Clinical (Isolated) HIT Rapid Onset HIT Heparin Induced Thrombocytopenia with Thrombosis (HITT)
23 Clinical HIT Antibody formation after heparin administration is accompanied by unexplained platelet fall 50% Fall typically begins 5-10 days after heparin administration Thrombocytopenic levels (i.e. 50% fall or to <150 x 10 9 /L) reached 7 to 14 days after starting heparin Keeling et al. Br Soc Haem 2006;133:
24 The Temporal Nature of HIT Warkentin et al. NEJM 2001;344:
25 Rapid-Onset HIT 25-30% of patients <4 days post heparin administration associated with previous heparin exposure within past 100 days Keeling et al. Br Soc Haem 2006;133: Warkentin et al. NEJM 2001;344:
26 HITT HIT can be associated with clinical evidence of thrombosis Incidence ~50% of cases Warkentin et al. Chest 2004;126:311s-337s
27 HITT Warkentin. Arch Pathol Lab Med 2002;126: Menajovsky. Am J Med 2005;118:21s-30s Warkentin et al. Ann Int Med 1997;127:
28 Heparin-Induced Thrombocytopenia with Thrombosis: Loyola Experience ( ) Nand et al. Am J Hematol 1997;56;12-16
29 Heparin-Induced Thrombocytopenia with Thrombosis: Loyola Experience ( ) 29% HITT rate 9% rate of amputations 16% mortality Nand et al. Am J Hematol 1997;56;12-16
30 Laboratory Diagnosis
31 Laboratory Diagnosis Diagnosis of HIT is based on clinical presentation Identifying HIT antibodies is useful to corroborate diagnosis Clinical pretest probability must be established in order to determine the reliability of a positive or negative result
32 Keeling et al. Br Soc Haem 2006;133:
33 Warkentin. Arch Pathol Lab Med 2002;126: Menajovsky. Am J Med 2005;118:21s-30s
34 Serologic vs. Functional Assays Serologic Assays Detect circulating IgG, IgA, and IgM antibodies Have high sensitivity (> 97%) Limited specificity (~74-86%) Can detect PF4-heparin Abs in patients without HIT Can be improved if IgG s are only examined Commercially unavailable Recommended when clinical suspicion of HIT is high or intermediate Arepally et al. NEJM ;8:
35 Serologic vs. Functional Assays Functional Assays Measure platelet activation Detect heparin-dependent antibodies capable of binding and activating Fc receptors on platelets Sensitivity > 90% at experienced labs Specificity ~ % Labor intensive Not widely available Recommended to confirm HIT in patients with intermediate probability with indeterminate serologic testing Arepally et al. NEJM ;8:
36 Warkentin. Arch Pathol Lab Med 2002;126:
37 Treatment
38 De Nisio et al.. NEJM 2005;353:
39 Fondaparinux Renal Approved for DVT prophylaxis, not HIT treatment Arepally et al. NEJM ;8:
40 DTI-VKA Overlap Warkentin et al. Chest 2004;126:311s-337s
41 Warfarin for HIT Can cause venous limb gangrene when given as monotherapy for HIT Due to associated hypercoagulability and depletion of Protein C Administered when platelet count has recovered ( 100 x 10 9 /L) during HIT treatment Warkentin et al. Ann Int Med 1997; 127: & Chest 2004;126:311s-337s
42 LMWH for Treating HIT Retrospective cohort study of 89 patients Following dx of HIT, patients received: LMWH (n = 36) Warfarin (n = 27) Danaparoid (n = 9) Nothing (n = 17) Ranze et al. Ann Hematol 2000;79:P198
43 LMWH for Treating HIT New thrombosis: 47.2% of patients receiving LMWH 33.3% of patients receiving warfarin 23.5% of patients receiving no anticoagulation 0% of patients receiving danaparoid 36.1% of patients treated with LMWH had recovery of platelets, compared with other approaches (~81% overall, p < 0.001) Ranze et al. Ann Hematol 2000;79:P198
44 Prevention
45 Not proven in other non-orthopaedic surgery settings Warkentin et al. Arch Int Med 2003;163: , NEJM 1995;332:1330-5, & Chest 2004;126:311s-337s UFH vs. LMWH in Preventing HIT LMWH is associated with lower incidence of HIT than UFH in postop orthopaedic patients
46 Martel et al. Blood 2005;106: )
47 Perioperative Considerations
48 Platelet Count Recommendations HIT risk > 1% (frequent): Patients receiving post-op antithrombotic prophylaxis with UFH Every-other-day platelet count monitoring between post-op days 4 to 14, or until UFH is stopped HIT risk 0.1 to 1% (infrequent): Medical/obstetric patients receiving prophylactic dose UFH (or LMWH after receiving UFH), post-op patients receiving prophylactic dose LMWH or intravascular catheter UFH flushes Platelet count monitoring every 2 to 3 days from day 4 to 14, or until heparin is stopped Warkentin et al. Chest 2004;126:311s-337s
49 Platelet Count Recommendations HIT risk < 0.1% (rare): Medical or obstetric patients receiving LMWH or UFH flushes Platelet count monitoring not needed Screening for subclinical HIT antibody seroconversion: Warkentin et al. Chest 2004;126:311s-337s
50 Prophylactic Platelet Transfusions Contraindicated if no evidence of active bleeding Associated with thrombotic events in anecdotal reports In severe thrombocytopenia, petechiae and mucocutaneous bleeding are not typical features of HIT Warkentin et al. Chest 2004;126:311s-337s
51 Cardiac or Vascular Surgery in Patients with Previous HIT No anamnestic immune response in HIT HIT antibodies are transient Warkentin et al. NEJM 2001;344:
52 Cardiac or Vascular Surgery in Patients with Previous HIT After confirmed seronegativity following HIT, antibodies do not always regenerate following repeat heparin challenge Regenerated antibodies do not occur sooner, or at stronger levels Warkentin et al. NEJM 2001;344:
53 Cardiac or Vascular Surgery in Patients with Previous HIT For HIT antibody negative patients: UFH is recommended for surgery Nonheparin anticoagulants should be used for preoperatively and postoperatively, if needed For acute or subacute HIT patients: Nonheparin anticoagulants are recommended unless surgery can be delayed until patients are HIT antibody negative Warkentin et al. Chest 2004;126:311s-337s
54 Warkentin et al. Chest 2004;126:311s-337s
55 Conclusions
56 This presentation is available for further review at:
57 The Perioperative Management of Heparin Induced Thrombocytopenia Chaitan K. Narsule, M.D. March 5, 2008
10/24/2013. Heparin-Induced Thrombocytopenia (HIT) Anticoagulation Management in ECMO Therapy:
Anticoagulation Management in ECMO Therapy: Heparin-Induced (HIT) Michael H. Creer, MD Professor of Pathology Director, Clinical Laboratories, Medical Co- Director, Hematopathology and Chief, Division
More informationHEPARIN-INDUCED THROMBOCYTOPENIA (HIT)
HEPARIN-INDUCED THROMBOCYTOPENIA (HIT) OBJECTIVE: To assist clinicians with the investigation and management of suspected and documented heparin-induced thrombocytopenia (HIT). BACKGROUND: HIT is a transient,
More informationHeparin-Induced Thrombocytopenia and Thrombosis: HITT Syndrome Update
Heparin-Induced Thrombocytopenia and Thrombosis: HITT Syndrome Update Surgery Grand Rounds February 18, 2011 Anne T. Neff, MD Director, Hemostasis & Thrombosis Clinic Case Presentation #1 43 yo male with
More informationTreatment and Prevention of Heparin-Induced Thrombocytopenia*
Supplement ANTITHROMBOTIC AND THROMBOLYTIC THERAPY 8TH ED: ACCP GUIDELINES Treatment and Prevention of Heparin-Induced Thrombocytopenia* American College of Chest Physicians Evidence-Based Clinical Practice
More informationHeparin-Induced Thrombocytopenia. Steven Baroletti, PharmD., M.B.A., BCPS Brigham and Women s Hospital
Heparin-Induced Thrombocytopenia Steven Baroletti, PharmD., M.B.A., BCPS Brigham and Women s Hospital Heparin-induced thrombocytopenia (HIT) A serious concern associated with thrombosis development following
More informationHeparin-induced thrombocytopenia (HIT) is an antibody-mediated,
Heparin-Induced Thrombocytopenia: Recognition, Treatment, and Prevention The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy Theodore E. Warkentin, MD, Chair; and Andreas Greinacher,
More informationHeparin-Induced Thrombocytopenia (HIT)
Heparin-Induced Thrombocytopenia (HIT) Joshua Ononuju, Pharm. D. Owensboro Medical Health Systems Objectives Overview Pathogenesis Risk factors Clinical Presentation and Diagnosis Treatment goals and options
More informationTreatment and Prevention of Heparin-Induced Thrombocytopenia
CHEST Supplement ANTITHROMBOTIC THERAPY AND PREVENTION OF THROMBOSIS, 9TH ED: ACCP GUIDELINES Treatment and Prevention of Heparin-Induced Thrombocytopenia Antithrombotic Therapy and Prevention of Thrombosis,
More informationDiagnosis and Management of Heparin-Induced Thrombocytopenia (HIT)
ASH CLINICAL PRACTICE GUIDELINES VENOUS THROMBOEMBOLISM (VTE) POCKET GUIDE Diagnosis and Management of Heparin-Induced Thrombocytopenia (HIT) A POCKET GUIDE FOR THE CLINICIAN DECEMBER 08 Allyson M. Pishko,
More informationDiagnosis & Management of Heparin-Induced Thrombocytopenia
Diagnosis & Management of Heparin-Induced Thrombocytopenia An Educational Slide Set American Society of Hematology 2018 Guidelines for Management of Venous Thromboembolism Slide set authors: Eric Tseng
More informationHeparin induced thrombocytopenia in the critically ill: How to interpret anti- PF4 antibody test results
Heparin induced thrombocytopenia in the critically ill: How to interpret anti- PF4 antibody test results Daniel H. Kett, M.D. Professor of Clinical Medicine Director MICU, Jackson Memorial Hospital University
More informationA Great Clinical Paradox. Narendranath Epperla MD Sowjanya Bapani MD Steven Yale MD, FACP
A Great Clinical Paradox Narendranath Epperla MD Sowjanya Bapani MD Steven Yale MD, FACP Initial Presentation 61 y/o Vietnam veteran with a past H/O hypertension, back pain and depression on Lisinopril,
More informationObjectives. Venous Thromboembolism (VTE) Prophylaxis. Case VTE WHY DO IT? Question: Who Is At Risk?
Objectives Venous Thromboembolism (VTE) Prophylaxis Rishi Garg, MD Department of Medicine Identify patients at risk for VTE Options for VTE prophylaxis Current Recommendations (based on The Seventh ACCP
More informationChallenges in Anticoagulation and Thromboembolism
Challenges in Anticoagulation and Thromboembolism Ethan Cumbler M.D. Assistant Professor of Medicine Hospitalist Medicine Section University of Colorado Denver May 2010 No Conflicts of Interest Objectives
More informationHeparin-induced thrombocytopenia (HIT; sometimes
Contemporary Reviews in Cardiovascular Medicine When Heparins Promote Thrombosis Review of Heparin-Induced Thrombocytopenia Ik-Kyung Jang, MD, PhD; Marcie J. Hursting, PhD Heparin-induced thrombocytopenia
More informationPage 1 of 6. Low 1 (score 0-3) Monitor platelets and signs and symptoms of thrombosis and continue heparin
Page 1 of 6 Estimate probability of HIT using the Four T s 1 Low 1 (score 0-3) Intermediate 1 (score 4-5) or High 1 (score 6-8) Monitor platelets and signs and symptoms of thrombosis and continue heparin
More informationHIT Me With Your Best Shot A Review of Heparin-Induced Thrombocytopenia
HIT Me With Your Best Shot A Review of Heparin-Induced Thrombocytopenia Presented by: Melissa Hawkins & Natalie LeBlanc Pharmacy Residents Horizon Health Network The Moncton Hospital November 6 th, 2010
More informationPerioperative Management of the Anticoagulated Patient
Perioperative Management of the Anticoagulated Patient Citywide Resident Perioperative Medical Consultation Conference 5/5/17 Matthew Eisen, MD Director, Anticoagulation Services MetroHealth Medical Center
More informationObesity, renal failure, HIT: which anticoagulant to use?
Obesity, renal failure, HIT: which anticoagulant to use? Mark Crowther with thanks to Dr David Garcia and others. This Photo by Unknown Author is licensed under CC BY-SA 1 2 Drug choices The DOACs have
More informationObjectives. Heparin. Heparin & HIT: State of the Art. Acknowledge Heparin (almighty) HIT? Why care? Is it HIT? It is HIT. Now what?
Heparin & HIT: State of the Art Erika R. Ketteler, MD MA NMVAHCS, Vascular Surgery Assistant Professor of Surgery, UNM Objectives Acknowledge Heparin (almighty) HIT? Why care? Is it HIT? It is HIT. Now
More informationASH Draft Recommendations for Heparin-Induced Thrombocytopenia. Draft
ASH Recommendations for Heparin-Induced Thrombocytopenia INTRODUCTION American Society of Hematology (ASH) guidelines are based on a systematic review of available evidence. Through a structured process,
More informationCLINICIAN UPDATE. Heparin-induced thrombocytopenia. Diagnosis and Management. Theodore E. Warkentin, MD
CLINICIAN UPDATE Heparin-Induced Thrombocytopenia Diagnosis and Management Theodore E. Warkentin, MD Heparin-induced thrombocytopenia (HIT) is an adverse drug reaction characterized by thrombocytopenia
More informationChallenges in Anticoagulation Bridging and Emerging Therapies. Disclosures and Relationships. Objectives. Dr. Cumbler has no conflicts of interest
Challenges in Anticoagulation Bridging and Emerging Therapies Ethan Cumbler MD FACP Associate Professor of Medicine Hospitalist Medicine Section University of Colorado Denver 2011 Disclosures and Relationships
More informationNew Antithrombotic and Antiplatelet Drugs in CAD : (Factor Xa inhibitors, Direct Thrombin inhibitors and Prasugrel)
New Antithrombotic and Antiplatelet Drugs in CAD : (Factor Xa inhibitors, Direct Thrombin inhibitors and Prasugrel) Limitations and Advantages of UFH and LMWH Biological limitations of UFH : 1. immune-mediated
More informationINDICATIONS FOR THROMBO-PROPHYLAXIS AND WHEN TO STOP ANTICOAGULATION BEFORE ELECTIVE SURGERY
INDICATIONS FOR THROMBO-PROPHYLAXIS AND WHEN TO STOP ANTICOAGULATION BEFORE ELECTIVE SURGERY N.E. Pearce INTRODUCTION Preventable death Cause of morbidity and mortality Risk factors Pulmonary embolism
More informationEpidemiology of Thrombosis in Patients with Malignancy. Cancer and Venous Thromboembolism. Chew HK, Arch Int Med, Feb Blom et al, JAMA, Feb 2005
Cancer and Venous Thromboembolism Objectives 1. Epidemiology of thrombosis in patients with malignancy 2. Anticancer agents and thrombosis 3. Current treatment protocols at UHN 4. Prevention of DVT 5.
More informationVenous Thrombo-Embolism. John de Vos Consultant Haematologist RSCH
Venous Thrombo-Embolism John de Vos Consultant Haematologist RSCH overview The statistics Pathogenesis Prophylaxis Treatment Agent Duration Incidental VTE Recurrence of VTE IVC filters CVC related thrombosis
More informationHeparin-induced thrombocytopenia (HIT)
Heparin-induced thrombocytopenia: Principles for early recognition and management JOHN R. BARTHOLOMEW, MD; SUSAN M. BEGELMAN, MD; AND AMJAD ALMAHAMEED, MD ABSTRACT Heparin-induced thrombocytopenia (HIT)
More informationWe are IntechOpen, the world s leading publisher of Open Access books Built by scientists, for scientists. International authors and editors
We are IntechOpen, the world s leading publisher of Open Access books Built by scientists, for scientists 4,100 116,000 120M Open access books available International authors and editors Downloads Our
More informationLow Molecular Weight Heparin for Prevention and Treatment of Venous Thromboembolic Disorders
SURGICAL GRAND ROUNDS March 17 th, 2007 Low Molecular Weight Heparin for Prevention and Treatment of Venous Thromboembolic Disorders Guillermo Escobar, M.D. LMWH vs UFH Jayer s sales pitch: FALSE LMW is
More informationPerioperative VTE Prophylaxis
Perioperative VTE Prophylaxis Gregory J. Misky, M.D. Assistant Professor of Medicine University Of Colorado Denver You recommend the following 72 y.o. man admitted for an elective R hip repair. Patient
More informationHIT in ECMO: a challenging complication
HIT in ECMO: a challenging complication Blanca Martinez SOC Anestesia e Rianimazione 2 Direttore R. Muzzi Azienda Ospedaliero-Universitaria SM della Misericordia di Udine martinez.blanca@aoud.sanita.fvg.it
More informationVenous Thromboembolism Prophylaxis
Approved by: Venous Thromboembolism Prophylaxis Vice President and Chief Medical Officer; and Vice President and Chief Operating Officer Corporate Policy & Procedures Manual Number: Date Approved January
More informationDEEP VEIN THROMBOSIS (DVT): TREATMENT
DEEP VEIN THROMBOSIS (DVT): TREATMENT OBJECTIVE: To provide an evidence-based approach to treatment of patients presenting with deep vein thrombosis (DVT). BACKGROUND: An estimated 45,000 patients in Canada
More informationSlide 1. Slide 2. Slide 3. Outline of This Presentation
Slide 1 Current Approaches to Venous Thromboembolism Prevention in Orthopedic Patients Hujefa Vora, MD Maria Fox, RN June 9, 2017 Slide 2 Slide 3 Outline of This Presentation Pathophysiology of venous
More informationEffect of under filling tube
Effect of under filling tube 2 What constitutes underfilling? A 4.5ml vacutainer collection tube should contain at least 4ml of blood Less than that could give falsely prolonged clotting times ALSO be
More informationPE and DVT. Dr Anzo William Adiga WatsApp or Call Medical Officer/RHEMA MEDICAL GROUP
PE and DVT Dr Anzo William Adiga WatsApp or Call +256777363201 Medical Officer/RHEMA MEDICAL GROUP OBJECTIVES DEFINE DVT AND P.E PATHOPHYSIOLOGY OF DVT CLINICAL PRESENTATION OF DVT/PE INVESTIGATE DVT MANAGEMENT
More informationESIM 2014 Clinical Case Presentation Israel. Ben-Sasson Maayan Bnei-Zion medical center Haifa
ESIM 2014 Clinical Case Presentation Israel Ben-Sasson Maayan Bnei-Zion medical center Haifa Presentation A 24 YO male,a ping-pong player, presented to the ER with acute onset of right upper extremity
More informationVenous Thromboembolism National Hospital Inpatient Quality Measures
Venous Thromboembolism National Hospital Inpatient Quality Measures Presentation Overview Review venous thromboembolism as a new mandatory measure set Outline measures with exclusions and documentation
More informationDisclosures. DVT: Diagnosis and Treatment. Questions To Ask. Dr. Susanna Shin - DVT: Diagnosis and Treatment. Acute Venous Thromboembolism (VTE) None
Disclosures DVT: Diagnosis and Treatment None Susanna Shin, MD, FACS Assistant Professor University of Washington Acute Venous Thromboembolism (VTE) Deep Venous Thrombosis (DVT) Pulmonary Embolism (PE)
More informationAnticoagulation for prevention of venous thromboembolism
Anticoagulation for prevention of venous thromboembolism Original article by: Michael Tam Note: updated in June 2009 with the eighth edition (from the seventh) evidence-based clinical practice guidelines
More informationHeparin Induced Thrombocytopenia (HIT) without Thrombocytopenia-A case report and a literature review
ISPUB.COM The Internet Journal of Hematology Volume 5 Number 2 Heparin Induced Thrombocytopenia (HIT) without Thrombocytopenia-A case report and a literature review I Ahmed, M Naglak, H Rashid Citation
More informationConsensus Statement for Management of Anticoagulants and Antiplatelet drugs in Patients with Hip Fracture
Consensus Statement for Management of Anticoagulants and Antiplatelet drugs in Patients with Hip Fracture Patients with hip fractures should be operated on within 36 hours of presentation wherever possible.
More informationManagement of Cancer Associated Thrombosis (CAT) where data is lacking. Tim Nokes Haematologist, Derriford Hospital, Plymouth
Management of Cancer Associated Thrombosis (CAT) where data is lacking Tim Nokes Haematologist, Derriford Hospital, Plymouth Contents Overview of the statistics and aetiology for Cancer Associated Thrombosis
More informationCURRENT & FUTURE THERAPEUTIC MANAGEMENT OF VENOUS THROMBOEMBOLISM. Gordon Lowe Professor of Vascular Medicine University of Glasgow
CURRENT & FUTURE THERAPEUTIC MANAGEMENT OF VENOUS THROMBOEMBOLISM Gordon Lowe Professor of Vascular Medicine University of Glasgow VENOUS THROMBOEMBOLISM Common cause of death and disability 50% hospital-acquired
More informationHematologic Disorders. Assistant professor of anesthesia
Preoperative Evaluation Hematologic Disorders Dr M.Razavi Assistant professor of anesthesia Anemia Evaluation needs to consider the extent and type of surgery, the anticipated blood loss, and the patient's
More informationCANCER ASSOCIATED THROMBOSIS. Pankaj Handa Department of General Medicine Tan Tock Seng Hospital
CANCER ASSOCIATED THROMBOSIS Pankaj Handa Department of General Medicine Tan Tock Seng Hospital My Talk Today 1.Introduction 2. Are All Cancer Patients at Risk of VTE? 3. Should All VTE Patients Be Screened
More informationHeparin-Induced Thrombocytopenia Causing Graft Thrombosis and Bowel Ischemia post Endovascular Aneurysm Repair
Heparin-Induced Thrombocytopenia Causing Graft Thrombosis and Bowel Ischemia post Endovascular Aneurysm Repair Abdulmajeed Altoijry, MD, MSc PGY3 Vascular Surgery McGill University Introduction Heparin
More informationHeparin-Induced Thrombocytopenia causing Adrenal Insufficiency
Heparin-Induced Thrombocytopenia causing Adrenal Insufficiency NATASHA MALKANI, MD LAHEY CLINIC INTERNAL MEDICINE, PGY-2 TUFTS UNIVERSITY SCHOOL OF MEDICINE Objective Describe mechanism of HIT Describe
More informationMisunderstandings of Venous thromboembolism prophylaxis
Misunderstandings of Venous thromboembolism prophylaxis Veerendra Chadachan Senior Consultant Dept of General Medicine (Vascular Medicine and Hypertension) Tan Tock Seng Hospital, Singapore Case scenario
More informationTHROMBOPROPHYLAXIS: NON-ORTHOPEDIC SURGERY
THROMBOPROPHYLAXIS: NON-ORTHOPEDIC SURGERY OBJECTIVE: To outline a practical approach for the prevention of venous thromboembolism (VTE) in patients undergoing non-orthopedic surgery. BACKGROUND: VTE is
More informationImplications from the ACCP 2012 Consensus Guidelines for the Management of Thrombosis: a case based approach
Implications from the ACCP 2012 Consensus Guidelines for the Management of Thrombosis: a case based approach Prof. I. Baumgartner Head Clinical and Interventional Angiology About the ACCP guidelines Widely
More informationNIH Public Access Author Manuscript Hematol Oncol Clin North Am. Author manuscript; available in PMC 2014 June 01.
NIH Public Access Author Manuscript Published in final edited form as: Hematol Oncol Clin North Am. 2013 June ; 27(3): 541 563. doi:10.1016/j.hoc.2013.02.001. Diagnosis and Management of Heparin-Induced
More informationDVT Pathophysiology and Prophylaxis in Medically Hospitalized Patients. David Liff MD Oklahoma Heart Institute Vascular Center
DVT Pathophysiology and Prophylaxis in Medically Hospitalized Patients David Liff MD Oklahoma Heart Institute Vascular Center Overview Pathophysiology of DVT Epidemiology and risk factors for DVT in the
More informationDisclosures. Learning Objectives. Financial: none. Off label discussion: Recommendations in lieu of data
Kathryn Hassell, MD Professor of Medicine, Division of Hematology University of Colorado Denver Disclosures Financial: none Off label discussion: Prothormbin complex concentrates for DOAC reversal Use
More informationUpdates in Diagnosis & Management of VTE
Updates in Diagnosis & Management of VTE Financial Disclosures-NONE TRACY MINICHIELLO, MD CHIEF, ANTICOAGULATION& THROMBOSIS SERVICE- SAN FRANCISCO VAMC PROFESSOR OF MEDICINE UNIVERSITY OF CALIFORNIA,
More informationVenous Thromboembolism (VTE) in Myeloma. Christine Chen May 2017
Venous Thromboembolism (VTE) in Myeloma Christine Chen May 2017 Objectives 1. Review the magnitude of the problem and why myeloma patients are at risk of VTE 2. Discuss thromboprophylaxis approaches in
More informationWith All the New Drugs, This is How I Treat Acute DVT and Superficial Phlebitis
BRIGHAM AND WOMEN S HOSPITAL With All the New Drugs, This is How I Treat Acute DVT and Superficial Phlebitis Gregory Piazza, MD, MS Division of Cardiovascular Medicine Brigham and Women s Hospital April
More informationNew Oral Anticoagulants Prevention and Treatment of DVT and PE
New Oral Anticoagulants Prevention and Treatment of DVT and PE Grigoris T Gerotziafas Groupe de Thrombose Equipe de recherche ER2UPMC Interactions cellulaires tumorales et leur environnement et réponses
More informationNICE Guidance: Venous thromboembolism (deep vein thrombosis and pulmonary embolism) in patients admitted to hospital 1
The College of Emergency Medicine Patron: HRH The Princess Royal Churchill House Tel +44 (0)207 404 1999 35 Red Lion Square Fax +44 (0)207 067 1267 London WC1R 4SG www.collemergencymed.ac.uk CLINICAL EFFECTIVENESS
More informationWMC PHARMACY ANTICOAGULATION PROTOCOL Current Revision: July 2017 GENERAL ORDER PROCESSING AND MANAGEMENT
WMC PHARMACY ANTICOAGULATION PROTOCOL Current Revision: July 2017 GENERAL ORDER PROCESSING AND MANAGEMENT - Entering orders for anticoagulation in Cerner Providers will enter individual orders (oneoffs)
More informationCADTH Rapid Response Report: ASA for Venous Thromboembolism Prophylaxis: Evidence for Clinical Benefit and Harm
CADTH Rapid Response Report: ASA for Venous Thromboembolism Prophylaxis: Evidence for Clinical Benefit and Harm P. Timothy Pollak, MD, PhD University of Calgary Rocky Mountain/ACP Internal Medicine Meeting,
More informationPREVENTION AND TREATMENT OF VENOUS THROMBOEMBOLISM
PREVENTION AND TREATMENT OF VENOUS THROMBOEMBOLISM International Consensus Statement 2013 Guidelines According to Scientific Evidence Developed under the auspices of the: Cardiovascular Disease Educational
More information(e.g. inclusion and exclusion criteria, diagnosis) anticoagulation Future management of HIT patients post acute phase
Title of Guideline (must include the word Guideline (not protocol, policy, procedure etc) Contact Name and Job Title (author) Guideline for the treatment of heparin induced thrombocytopenia (HIT) in adults
More informationHeparin-induced thrombocytopaenia (HIT) an overview: what does the nephrologist need to know and do?
Clin Kidney J (2013) 6: 563 567 doi: 10.1093/ckj/sft139 Editorial Comment Heparin-induced thrombocytopaenia (HIT) an overview: what does the nephrologist need to know and do? Tina Dutt 1 and Michael Schulz
More informationWhat You Should Know
1 New 2018 ASH Clinical Practice Guidelines on Venous Thromboembolism: What You Should Know New 2018 ASH Clinical Practice Guidelines on Venous Thromboembolism: What You Should Know The American Society
More informationMANAGEMENT OF OVERANTICOAGULATION AND PREOPERATIVE MANAGEMENT OF WARFARIN DOSE 1. GUIDELINES FOR THE MANAGEMENT OF AN ELEVATED INR
MANAGEMENT OF OVERANTICOAGULATION AND PREOPERATIVE MANAGEMENT OF WARFARIN DOSE 1. GUIDELINES FOR THE MANAGEMENT OF AN ELEVATED INR 1.1 Time to lower INR Prothrombinex-VF - 15 minutes Fresh Frozen Plasma
More informationChoosing and Managing Direct Oral Anticoagulants (DOACs)
Choosing and Managing Direct Oral Anticoagulants (DOACs) Ana G. Antun, MD, MSc Assistant Professor, Department of Hematology and Medical Oncology Winship Cancer Institute of Emory University 1 Outline
More informationVenous thrombosis is common and often occurs spontaneously, but it also frequently accompanies medical and surgical conditions, both in the community
Venous Thrombosis Venous Thrombosis It occurs mainly in the deep veins of the leg (deep vein thrombosis, DVT), from which parts of the clot frequently embolize to the lungs (pulmonary embolism, PE). Fewer
More informationDesirudin A Summary of Recent Data in Patients With or at Risk for Heparin-Induced Thrombocytopenia
A SUPPLEMENT TO Desirudin A Summary of Recent Data in Patients With or at Risk for Heparin-Induced Thrombocytopenia Jerrold H. Levy, MD, FAHA Department of Anesthesiology and Critical Care Emory University
More informationBridging anticoagulation definition
Bridging anticoagulation definition Giving a short-acting anticoagulant, consisting of sc LMWH or ev UFH for 10 to 12 day period during interruption of VKA therapy when the INR is not within therapeutic
More informationGestione peri-operatoria del paziente in terapia con antagonisti della vitamina K. B. Cosmi
Gestione peri-operatoria del paziente in terapia con antagonisti della vitamina K B. Cosmi Department of Angiology and Blood Coagulation S. Orsola-Malpighi University Hospital Bologna, Italy Overview Background
More informationClinical Practice Committee Anticoagulation Bridging Document
Original: 10/23/06 Last Updated: 10/30/07 Clinical Practice Committee Do patients on long term oral anticoagulant therapy who require short term interruption of warfarin for an elective invasive procedure
More informationHeparin-Induced Thrombocytopenia and Thrombosis
A Review Paper Heparin-Induced Thrombocytopenia and Thrombosis Vipul P. Patel, MD, Matthew Bong, MD, and Paul E. Di Cesare, MD Abstract Heparin-induced thrombocytopenia (HIT) and heparininduced thrombocytopenia
More informationIs There a Role for Prophylaxis in Cancer Patients During Therapy?
Victor F. Tapson, MD, FCCP, FRCP Professor of Medicine Director, Center for Pulmonary Vascular Disease Division of Pulmonary and Critical Care Duke University Medical Center Durham, N.C. USA Is There a
More informationFactor Xa Inhibition in the Management of Venous Thromboembolism: Important Safety Information. Important Safety Information (cont d)
Factor Xa Inhibition in the Management of Venous Thromboembolism: The Role of Fondaparinux WARNING: SPINAL/EPIDURAL HEMATOMAS Epidural or spinal hematomas may occur in patients who are anticoagulated with
More informationDEEP VENOUS THROMBOSIS A PRACTICAL APPROACH TO IMPROVING CLINICAL OUTCOMES
DEEP VENOUS THROMBOSIS A PRACTICAL APPROACH TO IMPROVING CLINICAL OUTCOMES Jose M. Borromeo M.D. Vascular Surgeon Iowa Heart Center Disclosures: AstraZeneca Pharmaceuticals Cook CVRx LeMaitre Vascular,
More informationADVOCATE HEALTHCARE GUIDELINE FOR ANTITHROMBOTIC REVERSAL
Minimal clinical evidence exists to support the efficacy of nonspecific procoagulant therapies that promote thrombin formation and antifibrinolytics in the setting of antithrombotic-related bleeding. Hemostatic
More informationUpdates in Diagnosis & Management of VTE
Updates in Diagnosis & Management of VTE TRACY MINICHIELLO, MD CHIEF, ANTICOAGULATION& THROMBOSIS SERVICE-SAN FRANCISCO VAMC PROFESSOR OF MEDICINE UNIVERSITY OF CALIFORNIA, SAN FRANCISCO Financial Disclosures-NONE
More informationRisk Factor Evaluation for Thrombosis and Bleeding in Pediatric Patients with Heart Disease
Risk Factor Evaluation for Thrombosis and Bleeding in Pediatric Patients with Heart Disease Kristen Nelson, MD Johns Hopkins University Director, Pediatric Cardiac Critical Care Why Does it Matter? Pediatric
More informationPerioperative Management of Anticoagulation
Perioperative Management of Anticoagulation Presented By: Nibal R. Chamoun, PharmD, BCPS Clinical Assistant Professor, Clinical Coordinator Lebanese American University, School of Pharmacy Presented at:
More informationHow to prevent thrombotic diseases? Sergio Fusco, MD
How to prevent thrombotic diseases? Sergio Fusco, MD Geriatric Division - Department of Internal Medicine Ospedale Dell'Angelo - Venice, Italy CONFLICT OF INTEREST DISCLOSURE I have no potential conflict
More information10/8/2012. Disclosures. Making Sense of AT9: Review of the 2012 ACCP Antithrombotic Guidelines. Goals and Objectives. Outline
Disclosures Making Sense of AT9: Review of the 2012 ACCP Antithrombotic Guidelines No relevant conflicts of interest related to the topic presented. Cyndy Brocklebank, PharmD, CDE Chronic Disease Management
More informationJoost van Veen Consultant Haematologist
Joost van Veen Consultant Haematologist Bridging anticoagulation - conclusion Aim Questions What is the evidence? Does oral anticoagulation need to be stopped and if so when? When and at what dose is alternative
More informationBlood Thinner Agent. Done by: Meznah Al-mutairi Pharm.D Candidate PNU Collage of Pharmacy
Blood Thinner Agent Done by: Meznah Al-mutairi Pharm.D Candidate PNU Collage of Pharmacy Outline: Blood thinner agent definition. anticoagulants drugs. Thrombolytics. Blood thinner agent Therapeutic interference
More informationVenous Thromboembolism Prophylaxis - Why Should We Care? Harry Gibbs FRACP FCSANZ Vascular Physician The Alfred Hospital
Venous Thromboembolism Prophylaxis - Why Should We Care? Harry Gibbs FRACP FCSANZ Vascular Physician The Alfred Hospital VTE is common and dangerous 5 VTE is Common VTE Incidence: 1.5 / 1000 per year
More informationNOTE: The first appearance of terms in bold in the body of this document (except titles) are defined terms please refer to the Definitions section.
TITLE VENOUS THROMBOEMBOLISM PROPHYLAXIS SCOPE Provincial Acute and Sub-Acute Care Facilities APPROVAL AUTHORITY Alberta Health Services Executive Committee SPONSOR Vice President, Quality and Chief Medical
More informationRisk factors for DVT. Venous thrombosis & pulmonary embolism. Anticoagulation (cont d) Diagnosis 1/5/2018. Ahmed Mahmoud, MD
Risk factors for DVT Venous thrombosis & pulmonary embolism Ahmed Mahmoud, MD Surgery ; post op especially for long cases, pelvic operations (THR), Trauma ; long bone fractures, pelvic fractures (posterior
More informationVenous thrombosis & pulmonary embolism. Ahmed Mahmoud, MD
Venous thrombosis & pulmonary embolism Ahmed Mahmoud, MD Risk factors for DVT Surgery ; post op especially for long cases, pelvic operations (THR), Trauma ; long bone fractures, pelvic fractures (posterior
More informationMabel Labrada, MD Miami VA Medical Center
Mabel Labrada, MD Miami VA Medical Center *1-Treatment for acute DVT with underlying malignancy is for 3 months. *2-Treatment of provoked acute proximal DVT can be stopped after 3months of treatment and
More informationAntiphospholipid Antibody Syndrome: Management Issues for the Hematologist
Antiphospholipid Antibody Syndrome: Management Issues for the Hematologist Wisconsin Institute of Discovery Karen Rossi/Bristol-Myers Squibb Morey A. Blinder, MD Washington University, St. Louis, MO March
More informationManaging Perioperative Anticoagulation. Edie Shen MD
Managing Perioperative Anticoagulation Edie Shen MD Anticoagulation VKA Warfarin (Coumadin) DOACs Direct Thrombin Inhibitor Dabigatran (Pradaxa) Factor Xa Inhibitor Rivaroxaban(Xarelto) Apixaban(Eliquis)
More informationMinimal prolongation of prothrombin time with extended exposure to argatroban
1 Minimal prolongation of prothrombin time with extended exposure to argatroban Renee K. McAlister, BS College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois Satoru Ito, Pharm.D., BCPS
More informationAre guidelines for anticoagulation useful in cancer patients?
Session 3 Striking a Balance Between Bleeding and the Risk of Thrombosis in Cancer Patients Are guidelines for anticoagulation useful in cancer patients? Sebastian Szmit Department of Pulmonary Circulation
More informationIntrinsic + Common = aptt. Extrinsic + Common = PT. Common Pathway
Anticoagulant Cases 12 11 Intrinsic + Common = aptt 9 8 10 7 4 Extrinsic + Common = PT 5 2 Common Pathway 1 Xa Inhibitors rivaroxaban (Xarelto) apixaban (Eliquis) edoxaban (Savaysa) What is true regarding
More informationEnsuring Safety of Anticoagulation Therapy
Ensuring Safety of Anticoagulation Therapy Abha Agrawal, MD, FACP Chief Medical Officer Kings County Hospital Clinical Associate Dean SUNY Downstate College of Medicine Brooklyn, NY NYACP Webinar April
More informationCOAGULATION INHIBITORS LABORATORY DIAGNOSIS OF PROTHROMBOTIC STATES REGULATION OF. ANTICOAGULANT PROTEIN DEFICIENCY Disease entities COAGULATION
LABORATORY DIAGNOSIS OF PROTHROMBOTIC COAGULATION INHIBITORS Tissue Factor Pathway Inhibitor (TFPI) Lipoprotein Associated Coagulation Inhibitor (LACI) Extrinsic Pathway Inhibitor (EPI) Complexes with
More informationADMINISTRATIVE CLINICAL Page 1 of 6
ADMINISTRATIVE CLINICAL Page 1 of 6 Anticoagulant Guidelines #2: REVERSAL OF OR MANAGEMENT OF BLEEDING WITH ANTICOAGULANTS Origination Date: Revision Date: Reviewed Date: 09/12 09/12, 01/13, 11/13, 11/15
More informationDental Management Considerations for Patients on Antithrombotic Therapy
Dental Management Considerations for Patients on Antithrombotic Therapy Warfarin and Antiplatelet Joel J. Napeñas DDS FDSRCS(Ed) Program Director General Practice Residency Program Department of Oral Medicine
More informationDENOMINATOR: All surgical patients aged 18 years and older undergoing procedures for which VTE prophylaxis is indicated in all patients
Measure #23 (NQF 0239): Perioperative Care: Venous Thromboembolism (VTE) Prophylaxis (When Indicated in ALL Patients) National Quality Strategy Domain: Patient Safety 2017 OPTIONS FOR INDIVIDUAL MEASURES:
More information