This is the podcast surgery. I see rounds. My name is Jeff Guy. I'm an associate professor of surgery and director of the burning unit at Vanderbilt University Medical Center. Today, the topic that I want to talk about is heparin-induced thrombocytopinia. I don't know about you or your practice, but I do know that in our intensive care units that, given the types of patients we take care of,

all of our patients have some sort of deep venous thrombosis prophylaxis.

In our typical unit, we will use the low molecularoid heparins.

And you may be using the low molecularoid heparins or our standard unfractioned heparins in your unit.

But whenever you're using heparin, the one thing that we're always looking at is the possible development of thrombocitopenia or the drop in the platelet count.

When the platelet count drops, one of the things we're always looking for is does this patient have heparin-induced thrombocytopinia? And we'll often draw labs, we'll stop the heparin, or go to a different modality of

deep venous thrombosis prophylaxis.

But I find that many people who were talking about this with either the residents or

medical staff or nursing don't really have a fine understanding what this problem is.

Recently, we had a patient who had a horrible case of hepar-induced thromocitipenia,

and it really illustrated a lot of some of the difficulties in managing these patients.

So at least for this podcast, I want to focus on what is hepar-induced thrombocitopenia,

how do we diagnose it, what's its path of physiology, and what are some of

our ways of treating it? And then in a subsequent podcast, I think I'm going to focus a little bit

on how we actually approach and make the diagnosis of deep venous thrombosis and pulmonary imboli

in 2007. Heparin-induced thromacopinia occurs due to the formation of antibodies directed against

heparin-bonded to a platelet factor 4.

So this is an antibody mediated phenomenon.

The body is creating antibodies to this heparin-bondid complex.

Work-contented colleagues in New England Journal Medicine in 1995, estimated that the frequency of heparin-induced thrombocytopinia

is about 1% to 5% when unfractured heparin is used,

but it's less than 1% when using the low molecular weight heparins.

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