HITS

• patho

  • caused by allergic reaction from admin of heparin
  • leads to formation of antibodies on platelet surface
  • causes release of thrombin and clotting of platelets
  • leads to thrombocytopenia
  • heparin has opposite effect and clots form
• at risk patients

  • ortho surgeries- totals, spinal
  • cardio- cabg, valve surgery, vascular surgery,
  • trauma
  • abruptio placentae
  • history of heparin use
• Nonimmune

  • thrombocytopenia in less than 5 days of heparin admin
  • slight decrease in platelets
  • no antibodies form on platelet surface
  • observe patient
  • resolves spontaneously
  • no complications
• immune

  • thrombocytopenia in 5-14 days of heparin admin
  • moderate/sever decrease in platelets
  • antibodies form on platelet surface
  • stop heparin
  • increased risk of thromboembolism
• diagnostics

  • received heparin
  • unexplained decrease in platelets (by 50%)
  • labs: ptt, pt/inr, cbc (h/h), elisa
  • 4 ts
• 4 ts

  • thrombocytopenia
  • timing (5-14 days)
  • thrombus/embolis
  • other- ruled out other possibilities
• management

  • thoroughly assess- look for petechiae, stroke, chest pain, sob, tachycardia, cyanosis, warm/red calf
  • monitor for thombis ssx
  • monitor platelet count, coags, h/h,
  • meds
  • SCDs, passive ROM
  • other heparin names: enoxaparin, lovenox, LMWH
  • no heparin for life
  • med alert bracelet
  • heparin placed as allergy
  • bleeding precautions
• bleeding precautions

  • bleeding ssx
  • care for epistaxis- lean forward
  • electric razor
  • activity restrictions
  • no OTC meds with ASA
  • soft bristle tooth brush
  • avoid injections and needle sticks
  • menstruation
  • prevent constipation with stool softners
• treatment

  • stop all heparin
  • pull lines with heparin coating (art line, central line)
  • stop ASA- aspirin plavix
  • start argatroban, lepirudin, bivalirudin (alternative anticoagulants)
  • antifibrinolytic therapy (aminocaproic acid/amicar; TXA)
  • glucocorticoids to increase platelet production (methylprednisolone, prednisone)
  • embolectomy
  • prevention
• Complication

  thrombosis/embolus
• thrombosis

  • DVT
  • PE- CTA or VQ lung scan
  • limb ischemia thrombosis
  • thrombotic stroke
  • MI
  • Bruising
  • petechiae