Talk:Heparin-induced thrombocytopenia

Synchronize with Thrombocytopenia

cross posted Thrombocytopenia#Heparin-induced thrombocytopenia and thrombosis (HITT) should be synchronized with Heparin-induced thrombocytopenia#Treatment, and summarize it. Could an expert do this please? --Hroðulf (or Hrothulf) (Talk) 09:12, 22 May 2008 (UTC)

Spontaneous form

Four patients with spontaneous HIT: doi:10.1016/j.amjmed.2008.03.012. Primary research but possibly worth mentioning. JFW | T@lk 12:16, 26 June 2008 (UTC)

ACCP

ACCP guideline doi:10.1378/chest.08-0677 JFW | T@lk 01:14, 3 October 2008 (UTC)

Sources

Once I get around to improving this article, I intend to use the following sources:

• Ahmed I, Majeed A, Powell R. Heparin induced thrombocytopenia: diagnosis and management update. Postgrad Med J 2007;83(983):575‐82. PMID 17823223. doi:10.1136/pgmj.2007.059188
• Keeling D, Davidson S, Watson H. The management of heparin-induced thrombocytopenia. Br J Haematol 2006;133(3):259‐69. PMID 16643427. doi:10.1111/j.1365-2141.2006.06018.x
• Selleng K, Warkentin TE, Greinacher A. Heparin-induced thrombocytopenia in intensive care patients. Crit Care Med 2007;35(4):1165‐76. PMID 17334253. doi:10.1097/01.CCM.0000259538.02375.A5
• Warkentin TE. Think of HIT. Hematology Am Soc Hematol Educ Program 2006:408‐14. PMID 17124091. doi:10.1182/asheducation-2006.1.408
• Warkentin TE, Greinacher A, Koster A, Lincoff AM (2008). "Treatment and prevention of heparin-induced thrombocytopenia: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition)". Chest. 133 (6 Suppl): 340S–380S. doi:10.1378/chest.08-0677. PMID 18574270. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)

Let's see what happens. JFW | T@lk 22:30, 23 November 2008 (UTC)

Rewriting

I don't usually do this, but today I had to refactor some content that was standing in the way: here. Much of the content was unsourced despite making numerical claims, and most of the sources were primary sources. Finally, much of the content was highly technical. I will be populating sections per WP:MEDMOS in due course. Please bear with me. JFW | T@lk 22:16, 25 November 2008 (UTC)

Beware of antiphospholipids

doi:10.1111/j.1538-7836.2009.03335.x JFW | T@lk 23:24, 23 July 2009 (UTC)

NEJM 2006

I had completely overlooked:

Arepally GM, Ortel TL (2006). "Clinical practice. Heparin-induced thrombocytopenia". N. Engl. J. Med. 355 (8): 809–17. doi:10.1056/NEJMcp052967. PMID 16928996. {{cite journal}}: Unknown parameter |month= ignored (help)

Let's see if I can get hold of it. JFW | T@lk 12:57, 9 August 2009 (UTC)

Treatment

As usual this article has been lying fallow because I was too chicken to write a good "treatment" section. I think we need to cover all three licensed anticoagulants, their monitoring and drawbacks. Perhaps a bit about the troubles about setting the target for lepirudin. JFW | T@lk 23:18, 8 September 2009 (UTC)

Could use some images of this condition

Similar to [1] or [2] Doc James (talk · contribs · email) 08:47, 15 December 2009 (UTC)

Haven't seen any. Have you got a few? JFW | T@lk 20:09, 15 December 2009 (UTC)

No it is no very common. Will keep my eyes open a get a picture when possible. That uptodate article I sent you expands a bit of epidemiology. As we switch over to LMWH HIT will be less common.Doc James (talk · contribs · email) 20:14, 15 December 2009 (UTC)

Warkentin is a bit more cautious about LMWH being less HIT-ogenic. The last case I treated was due to dalteparin. JFW | T@lk 23:38, 22 December 2009 (UTC)

GA Review

The following discussion is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

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This review is transcluded from Talk:Heparin-induced thrombocytopenia/GA1. The edit link for this section can be used to add comments to the review.

Reviewer: Triplestop x3 18:27, 17 December 2009 (UTC)

The sources appear to be reliable, and the coverage good. However I still see problems involving the clarity of this page.

The following parts of the lead may be confusing to the reader.

• Heparin-induced thrombocytopenia (HIT) without or with thrombosis (HITT) - This seems awfully shorthand, you should probably make this more clear.
• Shouldn't the term HIT be defined as an "immune mediated adverse drug reaction" that causes x y and z?
• "unfractionated" or "low molecular weight" Would it not be sufficient for the lead just to say due to the administration certain forms of the anticoagulant (blood clotting inhibitor) heparin?
  •  Done Changes to the intro all followed through. JFW | T@lk 18:56, 19 December 2009 (UTC)

Symptoms section looks fine.

The mechanism section:

• This section suddenly dives into a discussion on the presence of anti-bodies, however this is not summarized in the lead. It needs a more logical flow. The first two sentences sound irrelevant.
  •  Done Not sure what else I could do to improve flow. JFW | T@lk 18:56, 19 December 2009 (UTC)

• To make matters more complicated, the most commonly used other anticoagulant, warfarin, is contraindicated in this setting as there is a very high risk of warfarin necrosis; this is the development of skin gangrene in those receiving warfarin or a similar vitamin K inhibitor. If the patient was receiving warfarin at the time when HIT is diagnosed, the activity of warfarin is reversed with vitamin K. -- This part sounds unclear. Does having HIT make it more likely for one to develop skin gangrene with Warfarin? What does adding Vitamin K do to help?
  • Apparently HIT + warfarin therapy increases risk of gangrene markedly. I will make it clearer. JFW | T@lk 22:17, 28 December 2009 (UTC)
  • Vitamin K reverses the effect of warfarin and abates the risk of gangrene. I thought the flow of the text made that clear. JFW | T@lk 20:48, 30 December 2009 (UTC)

I'm going to go ahead and pass this. Sorry for the delay, as I was trying to get a third opinion. My biggest concern is the prose quality however I believe that this article is good enough for GA. Triplestop x3 21:27, 1 January 2010 (UTC)

The discussion above is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

Heparin IS natural, and found in the human body

I saw that the article mentioned that heparin is not naturally occurring, but that is obviously false. I cited my edit. I'm not a Wikipedia person, hope I did it right. 68.46.171.223 (talk) —Preceding undated comment added 00:11, 22 February 2010 (UTC).

The problem is that your edit introduced a non-sequitur. Pharmacological heparin is clearly immunogenic and your edit doesn't explain that. Please revise your contribution. JFW | T@lk 19:58, 22 February 2010 (UTC)

Heparin's not he problem with HIT; it's the sulfate portion that causes the adverse rxn. I don't have time to make extensive edits, but someone should look up the heparins tied with saccharides (eg heparin tetrasaccharide). You'll find that there is zero immunologic response with those drugs. By the way, wikipedia is a great resource and we all appreciate what you're doing, keep it up! 68.46.171.223 (talk) 03:43, 24 February 2010 (UTC)