4 research outputs found
LijeÄenje venske tromboembolije argatrobanom u bolesnice s heparinskom trombocitopenijom tipa ii ( HIT II ) - prikaz sluÄaja
Representing this patient our intention was to stress the importance of monitoring platelet number in patient on heparin therapy. We have, for the first time, in our hospital used reversibile thrombine inhibitor, that showed efficacy in treatening HIT II complications. HIT II immunologicaly caused side-effect of heparin therapy, characterized by decrease in thrombocyte number for more than 50 %, with increased inclination to thromboembolic incidents. The disease most commonly appears 5-10 days after initiation of mainly unfractionated heparin therapy. Application of ā4 T scoreā in clinical judgement for HIT probability, and laboratory investigation for presence of anti-heparin antibodies markedly contribute to in time detection and treatment of this illness. If anti-heparin antibodies are detected, heparin application must be stopped immidiately, and must be replaced by some anti-heparin anticoagulant preparation ( Fxa inhibitor, heparinoide, or direct inhibitor of thrombine). In time application of substitutional preparation for heparin markedly diminishes the occurence of thromboembolic complications.
We presented the case of patient hospitalized in our institution by reason of complete thrombosis of left illiac vein, joint femoral vein, deep veins of femoral region, popliteal vein and initial part of great saphenous vein. Treatment started by non-fractionated heparin and continued by warfarin, but the patient developed clinical feature of HIT II, so, current anticoagulant therapy was stopped , and fondaparinux was introduced. Although thrombocyte number increased, D-dimers were in additional rise, and patient developed pulmonary embolism. Reversible thrombin inhibitor argatroban was introduced in therapy in daily dose of 2 Ī¼g/kg/min in continual infusion lasting 15 days, followed by continual APTT monitoring,in therapeutic range 1.5-2 times of basic value. Rise in platelet number was monitored, decrease of D-dimer, and local clinical improvement. Marginal recanalization of veins in left femoral region and complete passage of popliteal vein were documented by color doppler.
Further, clinical estimation of HIT II probability using ā4Tā graduating system, and laboratory investigation to antiheparin antibodies, had significant role in diagnosis confirmation, and in selecting suitable substitutional preparation for heparin.Prikazom smo željeli naglasiti važnost praÄenja broja trombocita kod lijeÄenja heparinom. Uporabili smo po prvi puta reverzibilni inhibitor trombina; koji je pokazao uÄinkovitost u lijeÄenju komplikacija HIT-a II. HIT II je imunoloÅ”ka nuspojava heparinske terapije praÄena trombocitopenijom > 50% i poveÄanom sklonoÅ”Äu tromboemboliji. NajÄeÅ”Äe se javlja 5. do 10. dana terapije nefrakcioniranim heparinom. Otkrivanju i lijeÄenju ove nuspojave znaÄajno pridonosi primjena ā 4T zbiraā i otkirvanje prisutnosti protutijela na heparin. Ukoliko se protutijela dokažu; heparin se iskljuÄuje i nastavlja se ne-heparinskim antikoagulansom (inhibitorom FX a; heparinoidom ili direktnim inhibitorom trombina); Äime se smanjuje rizik tromboembolije. Prikazali smo sluÄaj bolesnice s kompletnom trombozom lijeve ilijaÄne vene; zajedniÄke femoralne vene; dubokih vena natkoljenice; poplitealne vene i poÄetnog dijela velike vene safene. LijeÄenje je zapoÄelo nefrakcioniranim heparinom i nastavljeno varfarinom. Bolesnica je razvila kliniÄku sliku HIT-a II. Prekinuta se dosadaÅ”nja antikoagulantna terapija i uvoden je fondaparinux. Broj trombocita je poÄeo rasti; D-dimeri tako|er. Razvila se pluÄna embolija. LijeÄenje je nastavljeno reverzibilnim inhibitorom trombina argatrobanom u dnevnoj dozi od 2 Ī¼g/kg/min kontinuiranom infuzijom u trajanju od 15 dana. Pratili smo APTV; Äije su vrijednosti bile 1.5-2 puta duže od baziÄne vrijednosti. Broj trombocita je rastao; koncentracija D-dimera se snizila; nastupilo je lokalno kliniÄko poboljÅ”anje. Obojeni doppler je pokazao rubnu rekanalizaciju vena lijeve natkoljenice i potpunu prohodnost poplitealne vene. KliniÄka procjena vjerojatnosti HIT II s ā4Tā bodovnim sustava otkrivanja heparinskih protutijela imala je znaÄajnu ulogu u potvrdi dijagnoze i odluci o odabiru odgovarajuÄeg zamjenskog lijeka za heparin
LijeÄenje venske tromboembolije argatrobanom u bolesnice s heparinskom trombocitopenijom tipa ii ( HIT II ) - prikaz sluÄaja
Representing this patient our intention was to stress the importance of monitoring platelet number in patient on heparin therapy. We have, for the first time, in our hospital used reversibile thrombine inhibitor, that showed efficacy in treatening HIT II complications. HIT II immunologicaly caused side-effect of heparin therapy, characterized by decrease in thrombocyte number for more than 50 %, with increased inclination to thromboembolic incidents. The disease most commonly appears 5-10 days after initiation of mainly unfractionated heparin therapy. Application of ā4 T scoreā in clinical judgement for HIT probability, and laboratory investigation for presence of anti-heparin antibodies markedly contribute to in time detection and treatment of this illness. If anti-heparin antibodies are detected, heparin application must be stopped immidiately, and must be replaced by some anti-heparin anticoagulant preparation ( Fxa inhibitor, heparinoide, or direct inhibitor of thrombine). In time application of substitutional preparation for heparin markedly diminishes the occurence of thromboembolic complications.
We presented the case of patient hospitalized in our institution by reason of complete thrombosis of left illiac vein, joint femoral vein, deep veins of femoral region, popliteal vein and initial part of great saphenous vein. Treatment started by non-fractionated heparin and continued by warfarin, but the patient developed clinical feature of HIT II, so, current anticoagulant therapy was stopped , and fondaparinux was introduced. Although thrombocyte number increased, D-dimers were in additional rise, and patient developed pulmonary embolism. Reversible thrombin inhibitor argatroban was introduced in therapy in daily dose of 2 Ī¼g/kg/min in continual infusion lasting 15 days, followed by continual APTT monitoring,in therapeutic range 1.5-2 times of basic value. Rise in platelet number was monitored, decrease of D-dimer, and local clinical improvement. Marginal recanalization of veins in left femoral region and complete passage of popliteal vein were documented by color doppler.
Further, clinical estimation of HIT II probability using ā4Tā graduating system, and laboratory investigation to antiheparin antibodies, had significant role in diagnosis confirmation, and in selecting suitable substitutional preparation for heparin.Prikazom smo željeli naglasiti važnost praÄenja broja trombocita kod lijeÄenja heparinom. Uporabili smo po prvi puta reverzibilni inhibitor trombina; koji je pokazao uÄinkovitost u lijeÄenju komplikacija HIT-a II. HIT II je imunoloÅ”ka nuspojava heparinske terapije praÄena trombocitopenijom > 50% i poveÄanom sklonoÅ”Äu tromboemboliji. NajÄeÅ”Äe se javlja 5. do 10. dana terapije nefrakcioniranim heparinom. Otkrivanju i lijeÄenju ove nuspojave znaÄajno pridonosi primjena ā 4T zbiraā i otkirvanje prisutnosti protutijela na heparin. Ukoliko se protutijela dokažu; heparin se iskljuÄuje i nastavlja se ne-heparinskim antikoagulansom (inhibitorom FX a; heparinoidom ili direktnim inhibitorom trombina); Äime se smanjuje rizik tromboembolije. Prikazali smo sluÄaj bolesnice s kompletnom trombozom lijeve ilijaÄne vene; zajedniÄke femoralne vene; dubokih vena natkoljenice; poplitealne vene i poÄetnog dijela velike vene safene. LijeÄenje je zapoÄelo nefrakcioniranim heparinom i nastavljeno varfarinom. Bolesnica je razvila kliniÄku sliku HIT-a II. Prekinuta se dosadaÅ”nja antikoagulantna terapija i uvoden je fondaparinux. Broj trombocita je poÄeo rasti; D-dimeri tako|er. Razvila se pluÄna embolija. LijeÄenje je nastavljeno reverzibilnim inhibitorom trombina argatrobanom u dnevnoj dozi od 2 Ī¼g/kg/min kontinuiranom infuzijom u trajanju od 15 dana. Pratili smo APTV; Äije su vrijednosti bile 1.5-2 puta duže od baziÄne vrijednosti. Broj trombocita je rastao; koncentracija D-dimera se snizila; nastupilo je lokalno kliniÄko poboljÅ”anje. Obojeni doppler je pokazao rubnu rekanalizaciju vena lijeve natkoljenice i potpunu prohodnost poplitealne vene. KliniÄka procjena vjerojatnosti HIT II s ā4Tā bodovnim sustava otkrivanja heparinskih protutijela imala je znaÄajnu ulogu u potvrdi dijagnoze i odluci o odabiru odgovarajuÄeg zamjenskog lijeka za heparin
Smjernice Hrvatskog druÅ”tva za hematologiju i transfuzijsku medicinu u dijagnostiÄko-terapijskom postupku za trombocitopeniju izazvanu heparinom (HIT) [Croatian Society for Haematology and Transfusion Medicine Guidelines on the diagnosis and management of heparin induced thrombocytopenia (HIT)]
Heparin induced thrombocytopenia (HIT) is a serious complication of heparin administration. In the last decade, this clinical syndrome has come into the focus of interest, primarily because of the severe thromboembolic complications that may lead to lethal outcome. In addition, great improvements have been made in the treatment with direct thrombin inhibitors and in laboratory diagnosis of HIT. As guidelines for diagnostic and management of HIT upgrade the quality of patient treatment, activities for their development have been launched in the Republic of Croatia. Based on British Committee for Standards in Haematology (BCSH) recommendations on diagnostic and treatment of HIT from 2006, activities for the introduction of new assays for anti-heparin antibodies were launched in 2008 and 2009, including algorithm of laboratory testing for HIT, sheet for clinical assessment of HIT (4T score), and education oftransfusiologists and clinicians. Upon evaluation of the results collected during one-year period, the Croatian Society of Haematology and Transfusion Medicine nominated a task force for the development of guidelines for HIT in January 2010. Following wide-ranging discussion, the guidelines were adopted in May 2011
Croatian Society for Haematology and Transfusion Medicine Guidelines on the Diagnosis and Management of Heparin Induced Thrombocytopenia (HIT)
Trombocitopenija izazvana heparinom (HIT) teÅ”ka je nuspojava heparinske terapije. U posljednjih desetak godina ovaj kliniÄkopatoloÅ”ki sindrom u srediÅ”tu je interesa primarno zbog teÅ”kih tromboembolijskih komplikacija, koje mogu imati i smrtni ishod. Znatno poboljÅ”anje u lijeÄenju HIT-a, postignuto je primjenom direktnih inhibitora trombina u zamjenu za heparin, a laboratorijsko ispitivanje antiheparinskih protutijela znatno je unaprijedilo dijagnostiku HIT-a. UvoÄenje smjernica za dijagnostiÄko-terapijski postupak za HIT ima znatan uÄinak na kvalitetu lijeÄenja bolesnika. Godine 2008. u Republici Hrvatskoj (RH) pokrenut je niz aktivnosti u cilju uspostavljanja smjernica za HIT, temeljenih na britanskim preporukama za dijagnostiku i lijeÄenje trombocitopenije izazvane heparinom iz 2006. godine. Tijekom 2008/09. godine uvedeni su novi testovi za antiheparinska protutijela, algoritam laboratorijskog ispitivanja i obrazac za kliniÄku procjenu HIT-a te izobrazba transfuziologa i kliniÄara. U sijeÄnju 2010. godine na struÄnom sastanku Hrvatskog druÅ”tva za hematologiju i transfuzijsku medicinu (HDHTM), nakon evaluacije rezultata jednogodiÅ”nje primjene preporuka osnovana je radna skupina za donoÅ”enje smjernica HDHTM-a za HIT. Nakon usuglaÅ”avanja i javne rasprave smjernice su prihvaÄene u svibnju 2011. godine.Heparin induced thrombocytopenia (HIT) is a serious complication of heparin administration. In the last decade, this clinical syndrome has come into the focus of interest, primarily because of the severe thromboembolic complications that may lead to lethal outcome. In addition, great improvements have been made in the treatment with direct thrombin inhibitors and in laboratory diagnosis of HIT. As guidelines for diagnostic and management of HIT upgrade the quality of patient treatment, activities for their development have been launched in the Republic of Croatia. Based on British Committee for Standards in Haematology (BCSH) recommendations on diagnostic and treatment of HIT from 2006, activities for the introduction of new assays for anti-heparin antibodies were launched in 2008 and 2009, including algorithm of laboratory testing for HIT, sheet for clinical assessment of HIT (4T score), and education of transfusiologists and clinicians. Upon evaluation of the results collected during one-year period, the Croatian Society of Haematology and Transfusion Medicine nominated a task force for the development of guidelines for HIT in January 2010. Following wide-ranging discussion, the guidelines were adopted in May 2011