Tuesday April 24, 2007
Treating HIT with Xigris ?

Continuing our theme from yesterday on Heparin-Induced Thrombocytopenia (HIT), we found an interesting case report where treatment has been done with Xigris - drotrecogin alfa (activated) !

"A patient was administered drotrecogin alfa (activated) in addition to the standard of care for presumed severe sepsis and circulatory shock. Heparin-induced thrombocytopenia (HIT) and hepatic and splenic thromboses complicated her clinical course. Because drotrecogin alfa (activated) treatment is associated with improvement in thrombotic manifestations and thrombocytopenia, it was continued as the sole antithrombotic agent after the HIT became apparent. This approach was chosen despite the patient's severe hepatic and renal dysfunction, which made the use of direct thrombin inhibitors unfavorable. She survived with a reasonable outcome and salvage of her limbs. Although this case suggests a potential role of drotrecogin alfa (activated) in the management of HIT, systematic evaluation of its efficacy in this situation is warranted".



Reference:

Pharmacotherapy 2006;26(3):428-434

Wednesday April 11, 2007
Upper extremity deep vein thrombosis (UEDVT)

Upper extremity deep vein thrombosis (UEDVT) should no longer be regarded as an uncommon and benign disease. It is usually associated with risk factors, as central venous lines, malignancy, and coagulation defects. However, up to 20% of UEDVTs are apparently spontaneous. The clinical picture is characterized by swelling, pain, and functional impairment, although UEDVT may be completely asymptomatic.

Objective testing is mandatory prior to instituting anticoagulation because the prevalence of UEDVT is less than 50% in symptomatic subjects, and compression ultrasound or color Doppler represents the preferred diagnostic methods.

Up to 36% of the patients develop pulmonary embolism, which may be fatal. Unfractionated or low-molecular-weight heparin followed by oral anticoagulation should be regarded as the treatment of choice. Thrombolysis and surgery may be indicated in selected cases.