Patient has had approximately 2 previous hospital visits in 2010 -pneumonia -acute hypoglycemic episodes BNP-possible CHF/fluid overload Bipap-bi level positive airway pressure
Phyontadione-vitamin K
Note the drop from 138 which was her baseline
PF4-heparin neutralizing protein released by activated platelets Type I is Non immune mediated not associated with increased risk of thrombosis Up to 8% of patients will develop the antibody associated with HIT. 1-5% of patients on heparin will develop HIT with thrombocytopenia
Thrombotic complications develop in 20-50% of pts
HIT is difficult to diagnose because medical and surgical pts may have multiple causes for thrombocytopenia
A score is determined for each category. Scores can range from 0 to 8
Nadir=low point
Platelets rise 2-3 days after discontinuing heparin and return to normal with 4 to 10 days Antibodies disappear 2-3 months after cessation of therapy Atypical manifestations:heparin-induced skin necrosis, venous gangrene of limbs, anaphylactic-type reactions
Including heparin-bonded catheters, heparin flushes and LMWH should be avoided due to cross reactivity Which ones for reduced renal function? Argatroban at standard doses or lepirudin at reduced doses
First monitor aPTT 4 hours after start of infusion. Draw aPTT at least once daily during treatment—more if renal or hepatic impairment Dose adjustment based on crcl
Dose reduction based on crcl. Okay for hepatic impairment. Monitor activated clotting time
Monitor aPTT after 2 hours---adjust dose to get goal aPTT Do not exceed 100 seconds Metabolized by the liver—dose adjust in severe hepatic impairment dose of 0.5 mcg/kg/min
Is indicated for DVT in conjunction with
More like type 1, although presence of antibodies is confusing
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