Thread by @runthelistpod, Let's HIT the topic Heparin-induced Thrombocytopenia (HIT)!This #tweetorial is a deep [...]

Let& #39;s HIT the topic

https://abs.twimg.com/emoji/v2/... draggable="false" alt="💊" title="Tablette" aria-label="Emoji: Tablette"> Heparin-induced Thrombocytopenia (HIT)

https://abs.twimg.com/emoji/v2/... draggable="false" alt="🩸" title="Tropfen Blut" aria-label="Emoji: Tropfen Blut">!

This #tweetorial is a deep dive into Episode 43 of Run the List (RTL) on Thrombocytopenia: https://bit.ly/32feVfQ

Thanks">https://bit.ly/32feVfQ&q... @LeelaChock for covering this week’s topic!

Let& #39;s HIT the topic https://abs.twimg.com/emoji/v2/... draggable=

Heparin-induced Thrombocytopenia (HIT)https://abs.twimg.com/emoji/v2/... draggable="false" alt="🩸" title="Tropfen Blut" aria-label="Emoji: Tropfen Blut">!This #tweetorial is a deep dive into Episode 43 of Run the List (RTL) on Thrombocytopenia: https://bit.ly/32feVfQ&q... @LeelaChock for covering this week’s topic!" title="Let& #39;s HIT the topic https://abs.twimg.com/emoji/v2/... draggable="false" alt="💊" title="Tablette" aria-label="Emoji: Tablette"> Heparin-induced Thrombocytopenia (HIT)https://abs.twimg.com/emoji/v2/... draggable="false" alt="🩸" title="Tropfen Blut" aria-label="Emoji: Tropfen Blut">!This #tweetorial is a deep dive into Episode 43 of Run the List (RTL) on Thrombocytopenia: https://bit.ly/32feVfQ&q... @LeelaChock for covering this week’s topic!" class="img-responsive" style="max-width:100%;"/>

Thrombocytopenia is a broad topic!

In Ep. 43 of RTL, Dr. Robert Stern, @NavinKumarMD, & @sonorato11 go over a general approach to thrombocytopenia

https://abs.twimg.com/emoji/v2/... draggable="false" alt="👇" title="Rückhand Zeigefinger nach unten" aria-label="Emoji: Rückhand Zeigefinger nach unten">

Broadly, there are THREE umbrellas:

1.

https://abs.twimg.com/emoji/v2/... draggable="false" alt="⬆️" title="Pfeil nach oben" aria-label="Emoji: Pfeil nach oben"> destruction

2. Splenic sequestration

https://abs.twimg.com/emoji/v2/... draggable="false" alt="💪" title="Angespannter Bizeps" aria-label="Emoji: Angespannter Bizeps">

3.

https://abs.twimg.com/emoji/v2/... draggable="false" alt="⬇️" title="Pfeil nach unten" aria-label="Emoji: Pfeil nach unten"> production

https://www.runthelistpodcast.com/s/RTL_Thrombocytopenia.pdf">https://www.runthelistpodcast.com/s/RTL_Thr...

Thrombocytopenia is a broad topic!In Ep. 43 of RTL, Dr. Robert Stern, @NavinKumarMD, & @sonorato11 go over a general approach to thrombocytopenia https://abs.twimg.com/emoji/v2/... draggable=

Broadly, there are THREE umbrellas:1. https://abs.twimg.com/emoji/v2/... draggable="false" alt="⬆️" title="Pfeil nach oben" aria-label="Emoji: Pfeil nach oben"> destruction2. Splenic sequestration https://abs.twimg.com/emoji/v2/... draggable="false" alt="💪" title="Angespannter Bizeps" aria-label="Emoji: Angespannter Bizeps">3. https://abs.twimg.com/emoji/v2/... draggable="false" alt="⬇️" title="Pfeil nach unten" aria-label="Emoji: Pfeil nach unten"> production https://www.runthelistpodcast.com/s/RTL_Thr..." title="Thrombocytopenia is a broad topic!In Ep. 43 of RTL, Dr. Robert Stern, @NavinKumarMD, & @sonorato11 go over a general approach to thrombocytopenia https://abs.twimg.com/emoji/v2/... draggable="false" alt="👇" title="Rückhand Zeigefinger nach unten" aria-label="Emoji: Rückhand Zeigefinger nach unten">Broadly, there are THREE umbrellas:1. https://abs.twimg.com/emoji/v2/... draggable="false" alt="⬆️" title="Pfeil nach oben" aria-label="Emoji: Pfeil nach oben"> destruction2. Splenic sequestration https://abs.twimg.com/emoji/v2/... draggable="false" alt="💪" title="Angespannter Bizeps" aria-label="Emoji: Angespannter Bizeps">3. https://abs.twimg.com/emoji/v2/... draggable="false" alt="⬇️" title="Pfeil nach unten" aria-label="Emoji: Pfeil nach unten"> production https://www.runthelistpodcast.com/s/RTL_Thr..." class="img-responsive" style="max-width:100%;"/>

HIT (Heparin-induced thrombocytopenia), is classified under “

https://abs.twimg.com/emoji/v2/... draggable="false" alt="⬆️" title="Pfeil nach oben" aria-label="Emoji: Pfeil nach oben"> destruction”

HIT in-depth:

https://abs.twimg.com/emoji/v2/... draggable="false" alt="✨" title="Funken" aria-label="Emoji: Funken">It is *common*, occurring in 1 out of 5,000 hospitalized patients

https://abs.twimg.com/emoji/v2/... draggable="false" alt="✨" title="Funken" aria-label="Emoji: Funken">

https://abs.twimg.com/emoji/v2/... draggable="false" alt="💥" title="Symbol für eine Kollision" aria-label="Emoji: Symbol für eine Kollision">It’s a can’t miss dx! 50% of patients w/ HIT who are not appropriately treated go on to develop a thrombosis

https://abs.twimg.com/emoji/v2/... draggable="false" alt="💥" title="Symbol für eine Kollision" aria-label="Emoji: Symbol für eine Kollision">

HIT (Heparin-induced thrombocytopenia), is classified under “https://abs.twimg.com/emoji/v2/... draggable=

HIT risk factors?

https://abs.twimg.com/emoji/v2/... draggable="false" alt="⬆️" title="Pfeil nach oben" aria-label="Emoji: Pfeil nach oben"> duration/dose of heparin administration (can even happen w/ simple heparin flush!)

Type of heparin used: UFH > LMWH > fondaparinux

https://abs.twimg.com/emoji/v2/... draggable="false" alt="💊" title="Tablette" aria-label="Emoji: Tablette">

https://abs.twimg.com/emoji/v2/... draggable="false" alt="🩹" title="Pflaster" aria-label="Emoji: Pflaster">Surgical, trauma, cardiopulm bypass pts at

https://abs.twimg.com/emoji/v2/... draggable="false" alt="⬆️" title="Pfeil nach oben" aria-label="Emoji: Pfeil nach oben"> risk (maybe 2/2 increased heparin use, but MoA unknown)

Patient sex (F>M)

HIT risk factors?https://abs.twimg.com/emoji/v2/... draggable=

duration/dose of heparin administration (can even happen w/ simple heparin flush!)Type of heparin used: UFH > LMWH > fondaparinuxhttps://abs.twimg.com/emoji/v2/... draggable="false" alt="💊" title="Tablette" aria-label="Emoji: Tablette">https://abs.twimg.com/emoji/v2/... draggable="false" alt="🩹" title="Pflaster" aria-label="Emoji: Pflaster">Surgical, trauma, cardiopulm bypass pts at https://abs.twimg.com/emoji/v2/... draggable="false" alt="⬆️" title="Pfeil nach oben" aria-label="Emoji: Pfeil nach oben"> risk (maybe 2/2 increased heparin use, but MoA unknown)Patient sex (F>M)" title="HIT risk factors?https://abs.twimg.com/emoji/v2/... draggable="false" alt="⬆️" title="Pfeil nach oben" aria-label="Emoji: Pfeil nach oben"> duration/dose of heparin administration (can even happen w/ simple heparin flush!)Type of heparin used: UFH > LMWH > fondaparinuxhttps://abs.twimg.com/emoji/v2/... draggable="false" alt="💊" title="Tablette" aria-label="Emoji: Tablette">https://abs.twimg.com/emoji/v2/... draggable="false" alt="🩹" title="Pflaster" aria-label="Emoji: Pflaster">Surgical, trauma, cardiopulm bypass pts at https://abs.twimg.com/emoji/v2/... draggable="false" alt="⬆️" title="Pfeil nach oben" aria-label="Emoji: Pfeil nach oben"> risk (maybe 2/2 increased heparin use, but MoA unknown)Patient sex (F>M)" class="img-responsive" style="max-width:100%;"/>

HIT mechanism:

https://abs.twimg.com/emoji/v2/... draggable="false" alt="▶" title="Nach rechts zeigendes Dreieck" aria-label="Emoji: Nach rechts zeigendes Dreieck"> Heparin

https://abs.twimg.com/emoji/v2/... draggable="false" alt="💊" title="Tablette" aria-label="Emoji: Tablette"> complexes w/ platelet factor 4 (PF-4), a protein released by platelets

https://abs.twimg.com/emoji/v2/... draggable="false" alt="▶" title="Nach rechts zeigendes Dreieck" aria-label="Emoji: Nach rechts zeigendes Dreieck"> B-cells make IgG antibodies (~5-7 days after heparin exposure) to the PF4-heparin complex

https://abs.twimg.com/emoji/v2/... draggable="false" alt="🧪" title="Test tube" aria-label="Emoji: Test tube">

https://abs.twimg.com/emoji/v2/... draggable="false" alt="▶" title="Nach rechts zeigendes Dreieck" aria-label="Emoji: Nach rechts zeigendes Dreieck"> IgG then binds these heparin-PF4 complexes to platelets and then…

HIT mechanism: https://abs.twimg.com/emoji/v2/... draggable=

(HIT MoA cont.):

IgG-PF4-heparin complexes bind platelets causing BOTH:

https://abs.twimg.com/emoji/v2/... draggable="false" alt="1⃣" title="Tastenkappe Ziffer 1" aria-label="Emoji: Tastenkappe Ziffer 1">Thrombocytopenia by marking the platelets for

https://abs.twimg.com/emoji/v2/... draggable="false" alt="☠️" title="Totenkopf" aria-label="Emoji: Totenkopf">destruction

https://abs.twimg.com/emoji/v2/... draggable="false" alt="☠️" title="Totenkopf" aria-label="Emoji: Totenkopf"> via splenic macrophages (type II hypersensitivity rxn)

AND

https://abs.twimg.com/emoji/v2/... draggable="false" alt="2⃣" title="Tastenkappe Ziffer 2" aria-label="Emoji: Tastenkappe Ziffer 2">Paradoxical PRO-thrombotic state by IgG Ab complexes

https://abs.twimg.com/emoji/v2/... draggable="false" alt="💥" title="Symbol für eine Kollision" aria-label="Emoji: Symbol für eine Kollision">activating

https://abs.twimg.com/emoji/v2/... draggable="false" alt="💥" title="Symbol für eine Kollision" aria-label="Emoji: Symbol für eine Kollision"> platelets!

(HIT MoA cont.):IgG-PF4-heparin complexes bind platelets causing BOTH:https://abs.twimg.com/emoji/v2/... draggable=

Sequelae include:

https://abs.twimg.com/emoji/v2/... draggable="false" alt="🔴" title="Roter Kreis" aria-label="Emoji: Roter Kreis">Thrombocytopenia to ~50-80k (usually >20K)

https://abs.twimg.com/emoji/v2/... draggable="false" alt="🟠" title="Orangefarbener Kreis" aria-label="Emoji: Orangefarbener Kreis">Paradoxical thrombosis (venous > arterial), despite thrombocytopenia!

https://abs.twimg.com/emoji/v2/... draggable="false" alt="🟡" title="Gelber Kreis" aria-label="Emoji: Gelber Kreis">(Rarely) anaphylaxis; HIT Ab may activate leukocytes

https://abs.twimg.com/emoji/v2/... draggable="false" alt="🟢" title="Grüner Kreis" aria-label="Emoji: Grüner Kreis">Skin necrosis at *heparin injection sites* (seen below) immediately suggests HIT!

https://abs.twimg.com/emoji/v2/... draggable="false" alt="🩺" title="Stethoskop" aria-label="Emoji: Stethoskop">

Sequelae include:https://abs.twimg.com/emoji/v2/... draggable=

Let’s review timing

https://abs.twimg.com/emoji/v2/... draggable="false" alt="⏰" title="Wecker" aria-label="Emoji: Wecker"> of HIT!

Suppose heparin is given on day 0:

https://abs.twimg.com/emoji/v2/... draggable="false" alt="🔸" title="Kleine orangene Raute" aria-label="Emoji: Kleine orangene Raute">d0-d1 = Rapid 50% drop (pt already has IgG Ab 2/2 heparin exposure w/i last 3 months)

https://abs.twimg.com/emoji/v2/... draggable="false" alt="🔹" title="Kleine blaue Raute" aria-label="Emoji: Kleine blaue Raute">d5-d7 = Rapid 50% drop (no prior heparin exposure)

https://abs.twimg.com/emoji/v2/... draggable="false" alt="🔸" title="Kleine orangene Raute" aria-label="Emoji: Kleine orangene Raute">d7-d14 after heparin withdrawal = Rapid drop ("delayed-onset HIT")

Let’s review timing https://abs.twimg.com/emoji/v2/... draggable=

of HIT!Suppose heparin is given on day 0:https://abs.twimg.com/emoji/v2/... draggable="false" alt="🔸" title="Kleine orangene Raute" aria-label="Emoji: Kleine orangene Raute">d0-d1 = Rapid 50% drop (pt already has IgG Ab 2/2 heparin exposure w/i last 3 months)https://abs.twimg.com/emoji/v2/... draggable="false" alt="🔹" title="Kleine blaue Raute" aria-label="Emoji: Kleine blaue Raute">d5-d7 = Rapid 50% drop (no prior heparin exposure)https://abs.twimg.com/emoji/v2/... draggable="false" alt="🔸" title="Kleine orangene Raute" aria-label="Emoji: Kleine orangene Raute">d7-d14 after heparin withdrawal = Rapid drop ("delayed-onset HIT")" title="Let’s review timing https://abs.twimg.com/emoji/v2/... draggable="false" alt="⏰" title="Wecker" aria-label="Emoji: Wecker"> of HIT!Suppose heparin is given on day 0:https://abs.twimg.com/emoji/v2/... draggable="false" alt="🔸" title="Kleine orangene Raute" aria-label="Emoji: Kleine orangene Raute">d0-d1 = Rapid 50% drop (pt already has IgG Ab 2/2 heparin exposure w/i last 3 months)https://abs.twimg.com/emoji/v2/... draggable="false" alt="🔹" title="Kleine blaue Raute" aria-label="Emoji: Kleine blaue Raute">d5-d7 = Rapid 50% drop (no prior heparin exposure)https://abs.twimg.com/emoji/v2/... draggable="false" alt="🔸" title="Kleine orangene Raute" aria-label="Emoji: Kleine orangene Raute">d7-d14 after heparin withdrawal = Rapid drop ("delayed-onset HIT")" class="img-responsive" style="max-width:100%;"/>

If suspecting HIT calculate a "4-T score"

The 4 T& #39;s are:

https://abs.twimg.com/emoji/v2/... draggable="false" alt="📌" title="Reißzwecke" aria-label="Emoji: Reißzwecke">Thrombocytopenia

https://abs.twimg.com/emoji/v2/... draggable="false" alt="📌" title="Reißzwecke" aria-label="Emoji: Reißzwecke">Timing

https://abs.twimg.com/emoji/v2/... draggable="false" alt="⌚️" title="Armbanduhr" aria-label="Emoji: Armbanduhr"> of Onset

https://abs.twimg.com/emoji/v2/... draggable="false" alt="📌" title="Reißzwecke" aria-label="Emoji: Reißzwecke">Thrombosis

https://abs.twimg.com/emoji/v2/... draggable="false" alt="📌" title="Reißzwecke" aria-label="Emoji: Reißzwecke">oTher causes of Thrombocytopenia.

A LOW score (<4 points) has a very HIGH negative predictive value (NPV) of 97 to 99%, and essentially *rules out* HIT

If suspecting HIT calculate a "4-T score"The 4 T& #39;s are:https://abs.twimg.com/emoji/v2/... draggable=

The positive predictive value (PPV) of a 4-T score of 4-5 is 10-20%, but a score >=6 is 40-80%

A 4-T score >=4 requires:

https://abs.twimg.com/emoji/v2/... draggable="false" alt="1⃣" title="Tastenkappe Ziffer 1" aria-label="Emoji: Tastenkappe Ziffer 1">Stopping all heparin products immediately

https://abs.twimg.com/emoji/v2/... draggable="false" alt="🛑" title="Stop sign" aria-label="Emoji: Stop sign">!

https://abs.twimg.com/emoji/v2/... draggable="false" alt="2⃣" title="Tastenkappe Ziffer 2" aria-label="Emoji: Tastenkappe Ziffer 2">An Anti–PF4–heparin ELISA test

https://abs.twimg.com/emoji/v2/... draggable="false" alt="🧪" title="Test tube" aria-label="Emoji: Test tube">

https://abs.twimg.com/emoji/v2/... draggable="false" alt="3⃣" title="Tastenkappe Ziffer 3" aria-label="Emoji: Tastenkappe Ziffer 3">Starting therapeutic NON-heparin anticoagulation (e.g. Argatroban

https://abs.twimg.com/emoji/v2/... draggable="false" alt="💊" title="Tablette" aria-label="Emoji: Tablette">)

The positive predictive value (PPV) of a 4-T score of 4-5 is 10-20%, but a score >=6 is 40-80%A 4-T score >=4 requires:https://abs.twimg.com/emoji/v2/... draggable=

Anti-PF4 test has high NPV (98-99%), but low PPV

a

https://abs.twimg.com/emoji/v2/... draggable="false" alt="➕" title="Fettes Pluszeichen" aria-label="Emoji: Fettes Pluszeichen"> anti-PF4 result requires confirmation w/ *gold standard functional test*: serotonin release assay (SRA)

How does SRA work?

If pt& #39;s serum has active heparin-PF4 IgG Ab

https://abs.twimg.com/emoji/v2/... draggable="false" alt="➡️" title="Pfeil nach rechts" aria-label="Emoji: Pfeil nach rechts"> activate donor platelets

https://abs.twimg.com/emoji/v2/... draggable="false" alt="➡️" title="Pfeil nach rechts" aria-label="Emoji: Pfeil nach rechts">

https://abs.twimg.com/emoji/v2/... draggable="false" alt="💥" title="Symbol für eine Kollision" aria-label="Emoji: Symbol für eine Kollision"> releasing serotonin

https://abs.twimg.com/emoji/v2/... draggable="false" alt="💥" title="Symbol für eine Kollision" aria-label="Emoji: Symbol für eine Kollision">

Anti-PF4 test has high NPV (98-99%), but low PPVa https://abs.twimg.com/emoji/v2/... draggable=

All pts w/ suspected or confirmed HIT need therapeutic (non-heparin) anticoagulation (AC)!

Why

https://abs.twimg.com/emoji/v2/... draggable="false" alt="💊" title="Tablette" aria-label="Emoji: Tablette">?

HIT Abs activate platelets

https://abs.twimg.com/emoji/v2/... draggable="false" alt="➡️" title="Pfeil nach rechts" aria-label="Emoji: Pfeil nach rechts">clots despite thrombocytopenia

For HIT: continue AC until platelet count >150K

For HIT-related clot: continue AC for 3 months (like any provoked clot)

All pts w/ suspected or confirmed HIT need therapeutic (non-heparin) anticoagulation (AC)!Whyhttps://abs.twimg.com/emoji/v2/... draggable=

?HIT Abs activate plateletshttps://abs.twimg.com/emoji/v2/... draggable="false" alt="➡️" title="Pfeil nach rechts" aria-label="Emoji: Pfeil nach rechts">clots despite thrombocytopeniaFor HIT: continue AC until platelet count >150KFor HIT-related clot: continue AC for 3 months (like any provoked clot)" title="All pts w/ suspected or confirmed HIT need therapeutic (non-heparin) anticoagulation (AC)!Whyhttps://abs.twimg.com/emoji/v2/... draggable="false" alt="💊" title="Tablette" aria-label="Emoji: Tablette">?HIT Abs activate plateletshttps://abs.twimg.com/emoji/v2/... draggable="false" alt="➡️" title="Pfeil nach rechts" aria-label="Emoji: Pfeil nach rechts">clots despite thrombocytopeniaFor HIT: continue AC until platelet count >150KFor HIT-related clot: continue AC for 3 months (like any provoked clot)" class="img-responsive" style="max-width:100%;"/>

[on AC]

@ASH_hematology suggests the following tx as initial anticoagulants in acute HIT

https://abs.twimg.com/emoji/v2/... draggable="false" alt="🩸" title="Tropfen Blut" aria-label="Emoji: Tropfen Blut">:

https://abs.twimg.com/emoji/v2/... draggable="false" alt="📝" title="Memo" aria-label="Emoji: Memo">Argatroban, bivalirudin, fondiparinux, danaparoid, or a DOAC

https://abs.twimg.com/emoji/v2/... draggable="false" alt="💊" title="Tablette" aria-label="Emoji: Tablette">Argatroban or bivalirudin = short half-lives (!)

https://abs.twimg.com/emoji/v2/... draggable="false" alt="⌛️" title="Sanduhr" aria-label="Emoji: Sanduhr">Short half-lives = indicated for critically ill or bleeding risk pts

[on AC] @ASH_hematology suggests the following tx as initial anticoagulants in acute HIThttps://abs.twimg.com/emoji/v2/... draggable=

:https://abs.twimg.com/emoji/v2/... draggable="false" alt="📝" title="Memo" aria-label="Emoji: Memo">Argatroban, bivalirudin, fondiparinux, danaparoid, or a DOAChttps://abs.twimg.com/emoji/v2/... draggable="false" alt="💊" title="Tablette" aria-label="Emoji: Tablette">Argatroban or bivalirudin = short half-lives (!)https://abs.twimg.com/emoji/v2/... draggable="false" alt="⌛️" title="Sanduhr" aria-label="Emoji: Sanduhr">Short half-lives = indicated for critically ill or bleeding risk pts" title="[on AC] @ASH_hematology suggests the following tx as initial anticoagulants in acute HIThttps://abs.twimg.com/emoji/v2/... draggable="false" alt="🩸" title="Tropfen Blut" aria-label="Emoji: Tropfen Blut">:https://abs.twimg.com/emoji/v2/... draggable="false" alt="📝" title="Memo" aria-label="Emoji: Memo">Argatroban, bivalirudin, fondiparinux, danaparoid, or a DOAChttps://abs.twimg.com/emoji/v2/... draggable="false" alt="💊" title="Tablette" aria-label="Emoji: Tablette">Argatroban or bivalirudin = short half-lives (!)https://abs.twimg.com/emoji/v2/... draggable="false" alt="⌛️" title="Sanduhr" aria-label="Emoji: Sanduhr">Short half-lives = indicated for critically ill or bleeding risk pts" class="img-responsive" style="max-width:100%;"/>

If pt is on warfarin,

https://abs.twimg.com/emoji/v2/... draggable="false" alt="🛑" title="Stop sign" aria-label="Emoji: Stop sign">hold warfarin

https://abs.twimg.com/emoji/v2/... draggable="false" alt="🛑" title="Stop sign" aria-label="Emoji: Stop sign"> & reverse with IV Vitamin K

https://abs.twimg.com/emoji/v2/... draggable="false" alt="🥦" title="Brokkoli" aria-label="Emoji: Brokkoli">

Seems strange right?

https://abs.twimg.com/emoji/v2/... draggable="false" alt="◾️" title="Schwarzes durchschnittliches kleines Quadrat" aria-label="Emoji: Schwarzes durchschnittliches kleines Quadrat">Warfarin has been shown to paradoxically WORSEN the hypercoagulable state in HIT

https://abs.twimg.com/emoji/v2/... draggable="false" alt="😱" title="Vor Angst schreiendes Gesicht" aria-label="Emoji: Vor Angst schreiendes Gesicht">

https://abs.twimg.com/emoji/v2/... draggable="false" alt="◽️" title="Weißes durchschnittliches kleines Quadrat" aria-label="Emoji: Weißes durchschnittliches kleines Quadrat">Once platelet count stabilizes, can re-start warfarin

https://abs.twimg.com/emoji/v2/... draggable="false" alt="👍" title="Thumbs up" aria-label="Emoji: Thumbs up">

If pt is on warfarin, https://abs.twimg.com/emoji/v2/... draggable=

in SUM:

1) HIT complexes both activate *and* deplete platelets (thrombocytopenia)

2) Use the 4-T score

https://abs.twimg.com/emoji/v2/... draggable="false" alt="🧮" title="Abacus" aria-label="Emoji: Abacus"> to assess for HIT

3) If >=4

https://abs.twimg.com/emoji/v2/... draggable="false" alt="🛑" title="Stop sign" aria-label="Emoji: Stop sign">heparin products, start non-heparin anticoagulation (not warfarin!), & send labs

4) Have a low threshold to look for thrombotic complications

in SUM:1) HIT complexes both activate *and* deplete platelets (thrombocytopenia)2) Use the 4-T scorehttps://abs.twimg.com/emoji/v2/... draggable=

to assess for HIT3) If >=4 https://abs.twimg.com/emoji/v2/... draggable="false" alt="🛑" title="Stop sign" aria-label="Emoji: Stop sign">heparin products, start non-heparin anticoagulation (not warfarin!), & send labs4) Have a low threshold to look for thrombotic complications" title="in SUM:1) HIT complexes both activate *and* deplete platelets (thrombocytopenia)2) Use the 4-T scorehttps://abs.twimg.com/emoji/v2/... draggable="false" alt="🧮" title="Abacus" aria-label="Emoji: Abacus"> to assess for HIT3) If >=4 https://abs.twimg.com/emoji/v2/... draggable="false" alt="🛑" title="Stop sign" aria-label="Emoji: Stop sign">heparin products, start non-heparin anticoagulation (not warfarin!), & send labs4) Have a low threshold to look for thrombotic complications" class="img-responsive" style="max-width:100%;"/>

REFs (1/2):

[1] https://theawkwardyeti.com/comic/blood-clot/
[2]https://theawkwardyeti.com/comic/blo... href=" https://www.runthelistpodcast.com/s/RTL_Thrombocytopenia.pdf
[3]https://www.runthelistpodcast.com/s/RTL_Thr... href="
[4]https://www.youtube.com/watch... href=" https://www.aruplab.com/testing/HIT
[5]https://www.aruplab.com/testing/H... href=" #article_citing_articles">http://www.nejm.org/doi/full/10.1056/nejmcp1411910 #article_citing_articles
[6]https://www.nejm.org/doi/full/... href=" https://www.semanticscholar.org/paper/Heparin-induced-thrombocytopenia-(HIT):-Review-of-Hogan-Berger/a1ab31b2e9ba719a81855a790145f86045842283/figure/0
[7]https://www.semanticscholar.org/paper/Hep... href=" #H19880151">https://www.uptodate.com/contents/clinical-presentation-and-diagnosis-of-heparin-induced-thrombocytopenia?search=HIT&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1 #H19880151
[8]https://www.uptodate.com/contents/... href=" #article_citing_articles">http://www.nejm.org/doi/full/10.1056/nejmcp1411910 #article_citing_articles
[9]https://www.nejm.org/doi/full/... href=" #article_citing_articles">http://www.nejm.org/doi/full/10.1056/nejmcp1411910 #article_citing_articles">https://www.nejm.org/doi/full/...

Heparin-Induced Thrombocytopenia | NEJM

Clinical Practice from The New England Journal of Medicine — Heparin-Induced Thrombocytopenia

https://theawkwardyeti.com/comic/blood-clot/

REFs (2/2):

[11] https://www.slideshare.net/skyecreativeone/medical-sample-13
[12]https://www.slideshare.net/skyecreat... href="
[13a]https://www.youtube.com/watch... href=" https://ashpublications.org/bloodadvances/article/2/22/3360/16129/American-Society-of-Hematology-2018-guidelines-for?searchresult=1&_ga=2.242345538.1943646382.1604025310-250888369.1604025310
[13b]https://ashpublications.org/bloodadva... href=" https://www.jahjournal.org/viewimage.asp?img=JApplHematol_2015_6_4_141_171993_f1.jpg
[15]https://www.jahjournal.org/viewimage... href=" https://www.runthelistpodcast.com/s/RTL_Thrombocytopenia.pdf">https://www.runthelistpodcast.com/s/RTL_Thr...

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