Heparin and platelets

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Specializes in ICU.

hey everyone, just curious to see what your practices are. When I have a patient on heparin, I always look at their labs, CBC/platelet counts. If its dropping, or low ill hold it and ask the doc. Not everyone does this, some it seems just blindly give it with no regard to if their thrombocytopenic or not. What do you guys do?

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Specializes in Pain, critical care, administration, med.

Is this Iv infusion or sub Q? Either way its good you look at the labs unless you have a doctors order you just can't hold it. Many reasons that the CBC/plt count fluctuate. Always get a order to hold never do it on your own.

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Specializes in ACNP-BC, Adult Critical Care, Cardiology.

I have to agree with lmccrn62. I hope you're not doing this in patients on Heparin drip.

If your patient is on Heparin SQ, the most common indication is VTE prophylaxis. VTE contributes to substantial cost of care as well as morbidity and mortality in hospitalized patients. When you make a decision to hold the Heparin SQ under the premise of a low platelet count, you are making the assumption that Heparin is the cause of thrombocytopenia.

Heparin-induced thrombocytopenia is a diagnosis that you can not make on your own. This requires testing to prove that it is present which requires an order from a licensed provider. If HIT is confirmed as the culprit, a decision needs to be made to transition to a different non-Heparin agent because HIT itself can predispose your patient to hypercoagulability.

Like was mentioned already, there are many other causes of thrombocytopenia other than Heparin. What could be worse is that by holding the Heparin SQ, you are no longer protecting your patient from the risk of VTE. The presence of thrombocyotpenia does not protect patients from developing clots. In fact, even cirrhotic patients with low platelet counts have shown to develop clots.

The best action is to discuss the platelet count with the responsible licensed provider or attending physician and go from there.

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Specializes in ICU.

Oy, sorry I guess you guys misunderstood. No I am not just holding the heparin and not talking to the doc, yes im refering to SC heparin. I am saying, if I have to give heparin SC in the morning, then I always check the CBC and platelets first. If I notice something off like they are dropping significantly over the last few days or suddenly become super low, I hold the heparin, then ASK THE DOC. Almost in all cases they say yes and will either just monitor labs, or do a HIT panel and they discontinue it, or if they say to continue it, or change it to something else then I give it and carry on. I am not randomly diagnosing my patients with HIT on my own, I am not a physican, but it is something I think about. I am holding it untill I speak with the doc during morning rounds to prevent further harm in case it is, or if the doc wants something different to be given.

Im just saying that I notice people dont take this into consideration and just give it always instead of thinking, hmm, the platelets have dropped, yes it could be many causes but one variable I have is heparin, I think i will hold it and call/talk with the doc and confirm if they want it given. thats all that I was getting at.

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Specializes in Acute Care Cardiac, Education, Prof Practice.
Oy, sorry I guess you guys misunderstood. No I am not just holding the heparin and not talking to the doc, yes im refering to SC heparin. I am saying, if I have to give heparin SC in the morning, then I always check the CBC and platelets first. If I notice something off like they are dropping significantly over the last few days or suddenly become super low, I hold the heparin, then ASK THE DOC. Almost in all cases they say yes and will either just monitor labs, or do a HIT panel and they discontinue it, or if they say to continue it, or change it to something else then I give it and carry on. I am not randomly diagnosing my patients with HIT on my own, I am not a physican, but it is something I think about. I am holding it untill I speak with the doc during morning rounds to prevent further harm in case it is, or if the doc wants something different to be given.

Im just saying that I notice people dont take this into consideration and just give it always instead of thinking, hmm, the platelets have dropped, yes it could be many causes but one variable I have is heparin, I think i will hold it and call/talk with the doc and confirm if they want it given. thats all that I was getting at.

Sounds like you are being a responsible nurse and critically thinking about your patient. Some people do and some people don't. If you are concerned however you could always ask for a parameter from the MD if you feel the patient is at risk. Or perhaps this is a policy change your facility could look at as Evidence-Based Practice?

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Specializes in Emergency, Med-Surg, Progressive Care.

We are required to check the platelet levels before giving Lovenox. If the value is under 100,000 or has dropped 25% since the last labs were taken we have to consult the physician. We don't give heparin very often, but I'd do the same thing.

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Specializes in Pediatric Cardiology.

I always check my patient's CBC prior to giving SC Heparin but it has to be really low for our docs to hold it. I agree with a PP, you are thinking critically and if it is held even once because you thought to look at their labs then I'd say you're doing a good job.

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I also agree that you need to be aware of what you are giving and the side-effects of it. It is responsible to ask the doc before giving a med if you have a concern. Our policy states to hold heparin if plts drop to under 100,000 or by more than 50% from baseline. But we also still discuss with MD. It is the same thing as checking before giving Lasix if renal labs are worsening and pt has a low BP. If in doubt, ask.

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