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2 Minute EBP Challenge

Monday, July 26, 2010
Ms. Shepard and DIC
This morning rapid response is called for Ms. Shepard who was admitted with a urinary tract infection and sepsis. Her blood pressure dropped during the evening hours and she is now hypotensive and is having difficulty breathing. Her IV sites are oozing and there is blood in the urinary catheter. Her physician suspects disseminated intravascular coagulation (DIC). The primary mechanism in the development of DIC is:

Monday, July 19, 2010
Thyrotoxicosis

Which of the following laboratory findings is indicative of thyrotoxicosis?

Monday, July 12, 2010
Urban CPR Patterns
In a recent study of inner-city neighborhoods, the authors found that out of hospital cardiac arrest was 2-3 times higher in some neighborhoods compared to others. In these high incidence neighborhoods what was the rate of bystander CPR?

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Home > 2 Minute EBP Challenge > Heparin-induced Thrombocytopenia

Heparin-induced Thrombocytopenia

Monday, January 25, 2010

Stay up-to-date the easy way!

How would you answer this question?

Your patient Mr. Kellogg is diagnosed with heparin-induced thrombocytopenia (HIT).  As his nurse you should anticipate that his physician will treat HIT with:

a. Platelet transfusions
b. Warfarin
c. Argatroban
d. Enoxaparin

The correct answer is "c" argatroban.

Thrombocytopenias are a collection of conditions that cause the platelet count to decrease.  There are many ways that platelets can become activated and depleted in the clotting process.  The most common reasons for drops in platelet counts are depletion from pre-existing conditions such as sepsis, trauma, or surgery.  Approximately 5% of patients that receive heparin will develop an immune response that activates platelets causing life-threatening clotting and occasional bleeding.  This condition is called heparin-induced thrombocytopenia.

Heparin is a drug that inhibits platelets from forming clots by inactivating thrombin and depressing platelet function directly.  The result is a decrease in clot formation and increased bleeding.  Preventing clot formation is beneficial in your patient with a pulmonary embolism or myocardial infarction, but adverse effects can occur such as intracranial hemorrhage with the use of heparin.

A small percentage of the population will develop an immune response to heparin that leads to activation of platelets, rather than inhibition.  This condition is referred to as heparin-induced thrombocytopenia (HIT), and results in the activation and depletion of platelets in the presence of therapeutic doses of heparin.

The most effective way to treat HIT is to discontinue all forms of heparin, including IV flushes.  Administering platelets to this patient can cause more clotting and increase the severity of symptoms.  Enoxaparin is a low-molecular weight heparin that can cause HIT, and warfarin can cause tissue necrosis in HIT.  Argatroban is an anticoagulant that will not worsen HIT.  Argatroban works by directly inhibiting thrombin and not by stimulating heparin antibodies, and is therefore safe in treating HIT.

From:  Woodruff, D.W. (2006). HIT: Now you see 'em , now you don't.  Nursing Made Incredibly Easy, 4(1); 53-55.

Congratulations to Toronda Jones-Hickson who won an autographed copy of my 101 Tips to Improve Your Nursing Care book for answering this week's question correctly.  Congratulations Toronda!    

Best wishes,
David W. Woodruff, MSN, RN-BC, CNS, CEN
President, Ed4Nurses, Inc.

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