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Regular APPT's are essential. Every so often out of the blue the patient will develop HITS - heparin induced thrombocytopenia Syndrome. Below is an exerpt from the Merck Manual online.
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The Merck Manual of Diagnosis and Therapy
Section 11. Hematology And Oncology
Chapter 133. Platelet Disorders
Topics
[General]
Thrombocytopenia
Platelet Dysfunction
Heparin-Induced Thrombocytopenia
Heparin-induced thrombocytopenia, the most important thrombocytopenia resulting from drug-related antibodies, occurs in up to 5% of patients receiving bovine heparin and in 1% of those receiving porcine heparin. Rarely, patients with heparin-induced thrombocytopenia develop life-threatening arterial thromboses (eg, thromboembolic occlusion of limb arteries, strokes, acute MI).
The thrombocytopenia results from the binding of heparin-antibody complexes to Fc receptors on the platelet surface membrane. Platelet factor 4, a cationic and strongly heparin-binding protein secreted from platelet alpha granules, may localize heparin on platelet and endothelial cell surfaces. In addition, platelet factor 4-heparin complexes are the principal antigens. Platelet clumps can form, causing vessel obstruction.
Heparin should be stopped in any patient who becomes thrombocytopenic. Because clinical trials have demonstrated that 5 days of heparin therapy are sufficient to treat venous thrombosis and because most patients begin oral anticoagulants simultaneously with heparin, heparin can usually be stopped safely. Laboratory assays do not aid these clinical decisions.
If the heparin drip is ordered without any checks then maybe you need to question the doctor about it. However, it is far from safe and the hospital policy to use weight based dosing should always be followed. Our hospital policy states that with our weight based heparin dosing, until the ptt is theraputic, as long as the dosage is being adjusted, the ptts get checked every 6hours and with every change.....It is dangerous not to monitor the ptts.
We have a heparin drip protocol. All the doctor has to do is write "heparin drip protocol" on the order sheet and we do the rest. It dictates how often ptt have to be drawn and when to adjust the rate. The doctors do not have to do anything. We just order the labs and write a protocol order.
rnsprad
2 Posts
DO DOCS EVER ORDER A CONTINUOUS HEPARIN DRIP WITHOUT FOLLOWING A WEIGHT BASED PROTOCOL (EX. 1000 U/HR) AND WITHOUT ANY PTTs ORDERED????? I HAVE BEEN TOLD THIS SITUATION CAN HAPPEN (BUT FORTUNATELY HASN'T HAPPENED ON MY SHIFT) AND THE DOC DOES NOT WANT THE DRIP ADJUSTED. CAN'T IMAGINE THAT! BUT WANT TO LEARN AHEAD OF TIME AND FROM EXPERIENCED NURSES. THANKS FOR YOUR HELP.