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Preventing-HIT or Heparin Induced Thrombocytopenia

8/29/2013

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Heparin, which is given intravenously is a medication that prevents the blood from clotting. The pill form of that medication is called Coumadin or it's generic is known as Warfarin. These medications are categorized as anticoagulants and are often called blood thinners. Some people may consider these medications as the diet pill for blood since it prevents thickening and the subsequent accumulation of platelets in the blood that may cause a clot to form in an artery. Blood clots generally lead to strokes and heart attacks which can cause death.

The problem with blood thinners or medications that regulate the blood in such a way to reduce instances of coagulation is that there is a delicate see saw between the blood being too thin and the blood being able to clot easily. If the blood is too thin, irregular bleeding or hemorrhage can occur. Other problems include: cholesterol embolism-fast lipids(pardon the pun), which is when the blood begins to release cholesterol from the badly damaged and clogged arteries as a result of the blood being suddenly thinned by the heparin or coumadin, warfarin. When the cholesterol is released into the blood stream, it ultimately damages other blood vessels and thus leads to kidney, renal and spinal failure. Yes, this can also lead to death.

With such a delicate balance to maintain, blood thinners have to be practically designed for the body in order for them to work properly. Many patients who begin to have problems with anticoagulant medications require hospital treatment or several doctors visits to regulate their medications, along with the problems of cholesterol. Tissue necrosis can also be a negative drawback by taking Heparin, Coumadin or Warfarin. This is caused by a deficiency known as a Protein C  deficiency. Protein C is a anticoagulant. Someone who lacks the proper amount of Protein C may develop blood clotting issues. Such conditions are called DVT, or deep vein thrombosis or PE, Pulmonary Embolism. When a blood thinner or anticoagulant is given the interruption of free blood flow causes the clots to travel elsewhere and prevents blood supply to the tissues and skin which causes gangrene and thrombosis.

To test how effective Coumadin, Heparin and Warfarin is in the body, a test called the PT/INR or international normalized ratio is used. This test is a measure of how long it takes for blood to clot. A high PT/INR means that a person is at risk of bleeding severely. A low PT/INR means that a person is at a high risk for developing blood clots.  The APTT test or Partial Thromboplastin Time test is used to monitor the effects of the Heparin, Coumadin or Warfarin. This is a reason why the PT/INR is tested on patients prior to surgery. Heparin's of a smaller molecule are considered LMWH or Low Molecular Weight Heparin that is measured in molecules of 4,000-6,000 daltons. These medications are given by injections and are not measured by PT/INR testing. The Heparin anti-Xa test is used to monitor Low Molecular Weight Heparin or a physician may order a CBC or complete blood count.

Heparin Induced Thrombocytopenia or HIT is caused by a low platelet count from taking Coumadin, Heparin or Warfarin. The antibodies in the blood then create new blood clots resulting from the platelets clumping or binding together or by attaching themselves to existing clots in the arteries or veins.

Regarding medications, there is Heparin, Coumadin or Warfarin and then there is this Low Molecular Weight Heparin. Coumadin and or Warfarin can be taken orally in pill form. The Low Molecular Weight Heparin is given by injection. The choice would depend on the person if they want to visit a doctor or hospital, inject themselves or would they just rather take it in pill form? People tend to treat their bodies like tanks with all these injections and IV's. Coumadin, Heparin and Warfarin can cause a person to hemorrhage, while LMWH or Low Molecular Weight Heparin can cause Thrombocytopenia. So now you have  a choice for the blood in your body  to either start or stop. The Heparin anti-Xa is not done as a routine or monthly test- so how do you know if the LMWH stuff is working? Which could be a problem especially if the insurance company will not pay for it because it does not meet medical necessity criteria. Ok, a platelet count will help, I guess. Hopefully, you won't be just another tank in the hospital or worse by then. 

Perhaps, if Coumadin and Warfarin were made in extended release medication form, this could possibly maintain or assist in regulating the amount of Coumadin or Warfarin the body recieves in the bloodstream on a daily basis. It may stabilize the blood so that it does not thin too quickly thus preventing hemorrhage and will stay in the body long enough to prevent thrombocytopenia,clotting or HIT by keeping anticoagulation levels consistant. Yes, this seems like another alternative to the medications and it's something you don't have to fast for!
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