Showing posts with label thrombocytopenia. Show all posts
Showing posts with label thrombocytopenia. Show all posts
Saturday, October 10, 2020
Heparin Induced Thrombocytopenia in Severe COVID-19 Patients
You see a doctor immediately and get
anti-coagulation going. You don't wait until it gets severe before you
see a doctor. I'm going to demand heparin. Don't tough it out at home.
I'm not medically trained so I know nothing, don't listen to me.
Friday, June 24, 2016
Systemic infusion and local irrigation with argatroban effective in preventing clot formation during carotid endarterectomy in a patient with heparin-induced thrombocytopenia.
What I don't understand is why with that blockage the solution isn't just to completely close it up as long as the Circle of Willis is complete rather than go through the risks of endarterectomy? But I have no medical training so someone with that could explain why I'm wrong.
http://dgcases.docguide.com/systemic-infusion-and-local-irrigation-argatroban-effective-preventing-clot-formation-during-carotid?overlay=2&
http://dgcases.docguide.com/systemic-infusion-and-local-irrigation-argatroban-effective-preventing-clot-formation-during-carotid?overlay=2&
A
therapeutic dilemma exists when patients with symptomatic carotid
stenosis and concomitant heparin-induced thrombocytopenia (HIT) are
advised to urgently undergo carotid endarterectomy (CEA) with heparin
therapy. After a 63-year-old man with HIT and multiple medical
comorbidities underwent emergent coronary artery bypass grafting,
postoperative imaging revealed plaque at the origin of the left internal
carotid artery with 80%-99% stenosis and minimal contralateral internal
carotid artery disease. During the patient's evaluation to undergo CEA
for symptomatic high-grade carotid stenosis, enzyme-linked immunosorbent
assay revealed persistent platelet factor 4 antibodies. The
endarterectomy was successfully performed while the patient received
argatroban, both as a continuous infusion and intermittent irrigation
during dissection of the plaque. Postoperatively, the drip was continued
for 24 hours, and the patient was discharged day 2 on a daily dose of
325 mg of aspirin. At the 6-month examination, Doppler ultrasound
revealed normal anterograde velocities with no evidence of stenosis, and
the patient noted no subsequent ischemic events. We now recommend
systemic intravenous and local argatroban irrigation to prevent
thromboembolic complications in CEA cases with HIT and renal
insufficiency. Bivalirudin for both systemic intravenous use and local
irrigation may be safer in patients without renal insufficiency because
of its shorter half-life.
from: Department
of Neurosurgery, University of Cincinnati College of Medicine and
Comprehensive Stroke Center at University of Cincinnati Neuroscience
Institute, Cincinnati, Ohio, USA.
as reported in: Serrone
JC, Andaluz N, Brink V, Zuccarello M, Ware SL. World Neurosurg. 2013
Jul-Aug:80(1-2):222.e15-8. doi: 10.1016/j.wneu.2013.01.037.
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