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CACP > HIT > Flashcards

HIT Flashcards

1
Q

what is the lab test that can be done to determine if pt has HIT?

A

ELISA

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2
Q

a strongly positive ELISA of what can reliably confirm the dx of HIT?

A

OD >1

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3
Q

what are the treatment options for HIT if it is a NON-surgrical patient

A

Fondaparinux

Direct Oral Anticoagulants

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4
Q

what is the treatment options for HIT for surgical pts?

A

Argatroban

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5
Q

what is the treatment options for HIT for pts undergoing cardiac surgery?

A

Bivalirudin

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6
Q

How long should the length of treatment be for pts with Isolated HIT? (HIT without Thrombosis?)

A

4 wks

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7
Q

How long should the length of treatment before pts with HITT (HIT with thombosis)

A

3 mths then assess risks vs benefits

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8
Q

what are some common drugs that can cause thrombocytopenia?

A

Carbamazepine
vancomycin
quindine

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9
Q

when should you order ELISA test?

A

after you do the 4 T score and pt has high or moderate suspicion of HIT

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10
Q

what are the 2 other tests that can be done if ELISA is not working or need additional test to confirm HIT?

A

SRA (serotonin release assay) - looks for heparin dependent Ab

P-Selectin Expression Assay (PEA)

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11
Q

what are the 4 steps that need to be done for all pts with suspected or confirmed HIT dx?

A
  1. discontinue all heparin (including flushes)
  2. dsicontinue/reverse warfarin with phytonadion
  3. obtain bilateral US for DVT
  4. start non-heparin anticoag immediately upon ELISA confirmation or if we are awaiting SRA/PEA results
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12
Q

what is the dose of argatroban for pts with normal hepatic function?

A

2mcg/kg/min

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13
Q

what is the goal APTT for argatroban for pts with normal hepatic function for HIT?

A

1.5-3x baseline APTT (max 100secs)

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14
Q

when should you measure APTT for argatroban?

A

every 2 hours after initiation or at any rate adjustment

once 2 consecutive APTTs are at target range then you can check daily

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15
Q

in what situation would you consider Bivalirudin for HIT?

A

pt to have urgent cardiac surgery with actue or subacute HIT or Cardiac Cath or PCI

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16
Q

what is the dose of bivalirudin for HIT? if CrCl is greater than 60ml/min?

A

0.15mg/kg/hr

NO BOLUS NEEDED EVER

17
Q

what is the dose of bivalirudin for HIT if Crcl is 30-60ml/min?

A

0.08mg/kg/hr

18
Q

what is the dose of bivalirudin for HIT if CrCl is less than 30

A

0.05mg/kg/hr

19
Q

what is the goal APTT for Bivalirudin for pts with normal hepatic function for HIT?

A

1.5-2.5 x baseline

20
Q

when should you measure APTT for bivalirudin?

A

every 2 hours if within therapeutic range x2 then check every 12 hours

21
Q

when transitioning from argatroban to warfarin what target INR should you aim for?

A

there is a false elevation of INR therefore target INR of 4 after a minimum of 5 days on dual anticoag therapy.

you can then stop infusion but if INR falls sub then restart infusion at previous rate - repeat daily until INR is therapeutic on only warfarin

22
Q

what can you define as plt recovery in HIT and how often do you monitor?

A

100-150

Monitor daily until they reach this normalize level

23
Q

If pt does not have planned surgery in the next 24 hours, but crCL is less thatn 30ml/min what agent would you recommend for HIT?

A

argatroban

24
Q

what is the agent of choice in pregnant women with HIT?

A

fondaparinux

25
Q

what is the agent of choice in pts mechanical valves or pediatrics?

A

Direct thrombin inhibitors (argatroban or bivalirudin)

26
Q

how much of a dose reduction do you need for HIT in pts with liver failure for argatroban?

A

1/4 the dose of argatoban is used

27
Q

which DOAC has the most evidence for HIT

A

Rivaroxaban

isolated HIT: 15mg BID until plts have recovered then 20mg daily

HITT: 15mg BID x 21 days then 20mg daily for at elast 3 months

CACP (8 decks)

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