Contents:
- Medical Video: Pharmacology - ANTICOAGULANTS & ANTIPLATELET DRUGS (MADE EASY)
- How it works heparin for medicine for heart disease
- What are the side effects of heparin?
- Why can heparin cause thrombocytopenia?
- How common is heparin thrombocytopenia?
- Is thrombocytopenia due to the side effects of heparin danger?
- How do doctors diagnose HIT?
- Not everyone may be prescribed heparin for medication for heart disease
Medical Video: Pharmacology - ANTICOAGULANTS & ANTIPLATELET DRUGS (MADE EASY)
Heparin is a medicine for heart disease to prevent possible complications that can be fatal, such as heart attacks and blood clots. Heparin is also commonly used for the prevention of blood clots or postoperative thrombosis. But like other drugs, heparin can cause side effects. One of the side effects of heparin to watch out for is thrombocytopenia.
Before examining more deeply about the side effects of this one heart disease medicine, it's good to know first how heparin works.
How it works heparin for medicine for heart disease
Blood clots in the arteries leading to the heart can cause acute coronary syndromes, such as unstable angina (feeling of tightness in the chest) or heart attack. To prevent and / or overcome this, blood thinning agents (anticoagulants) such as heparin are needed.
Heparin works to prevent blood clots by activating antithrombin III to block the action of thrombin and fibrin, two factors needed to freeze blood. Through this barrier to activation of thrombin and fibrin, heparin frustrates the blood clotting process.
What are the side effects of heparin?
Heparin heart disease medications have some side effects that you need to know. Some of them are:
- Bleeding: Heparin works to thin the blood, as a result the body will be more susceptible to bleeding. If it occurs continuously, the dose of heparin must be stopped immediately and the antidote is given, protamine sulfate.
- Can trigger an allergic reaction and anaphylactic shock
- Osteoporosis: occurs in 30% of patients who are dosed on long-term heparin. Heparin can accelerate the process of bone loss.
- Improve liver transaminase enzymes
- Thrombocytopenia (Heparin - induced thrombocytopenia /HIT)
Why can heparin cause thrombocytopenia?
Thrombocytopenia is a unique side effect of heparin heart disease medication. Thrombocytopenia occurs due to a lack of platelets or platelets, blood cells that play an important role in the blood clotting process. Generally a decrease in platelet count will increase the risk of bleeding. That is why the common symptoms of thrombocytopenia include easy nosebleeds and bruises, old wounds healed, and heavy menstrual bleeding.
However, when thrombocytopenia is specifically triggered by the use of heparin, aka HIT, the risk of thrombosis or blockage of the arteries is greater than bleeding. In fact, the decrease in platelets in HIT rarely reaches 20,000 / ul. This is influenced by the fact that HIT occurs due to the presence of body antibodies to the Heparin-PF4 complex.
In the body, heparin will bind with Platelet Specific Protein Factor 4 (PF4). This complex will be recognized by antibodies. Then after binding to the Heparin-PF4 complex, the antibodies will bind to the receptors on the platelets, causing platelet activation. Activation of platelets will result in the formation of blood vessel blockages. Simply put, heparin which is supposed to work inhibits blood clotting, in some people it turns out to be the opposite: it triggers platelet activation so that blood clots and clogs arteries.
How common is heparin thrombocytopenia?
For people who are taking heparin for the first time, HIT can occur 5-14 days after dosing begins. In patients who have used this heart drug before, side effects of heparin can appear earlier (less than 5 days after therapy begins). Symptoms of HIT can appear late in some people, approximately 3 weeks after the dose is stopped.
Some sources say HIT is more common in patients taking postoperative heparin and women who have heart disease prescribed this drug.
Is thrombocytopenia due to the side effects of heparin danger?
HIT is a medical condition that is dangerous if it is not detected. According to Medscape, 6-10% of HIT patients die. For this reason, we need to know "4T" in patients who are taking heparin:
- Thrombocytopenia (decreased body platelet count)
- Timing from a decrease in platelet count
- Thrombosis (blockage)
- There are no other causes of thrombocytopenia.
How do doctors diagnose HIT?
HIT can be detected by finding a decrease in platelets up to <100,000 / ul or a decrease of> 50% of platelet value before therapy. About 50% of HIT patients experience blocked arteries (Heparin induced thrombocytopenia and thrombosis - HITT). To diagnose thrombosis an examination can be performed doppler.
If the doctor detects signs of HIT, the doctor will do the following:
- Immediately stop the dose of heparin
- Replace heparin with other anticoagulants. Here anticoagulants must still be given given the high risk of blockages in HIT, and given up + 1 month after platelet levels return to normal. Warfarin administration should only be given after platelet levels return to baseline.
- Platelet or platelet transfusions should not be given.
- Evaluation of blockages (thrombosis) with doppler or other examinations.
Some literature recommends additional checks for HIT, namely with Enzyme Linked Assay (ELISA) to detect antibodies to the heparin-PF4 complex; and serotonin release assay to see platelet activation. Serotonin linked assay more accurate in detecting HIT, but it is still difficult to find a health center that has this examination in Indonesia. The risk of thrombosis can be seen with levels of circulating antibodies.
Not everyone may be prescribed heparin for medication for heart disease
Seeing the risk of unique side effects of heparin, this heart disease medication should not be given to patients with a history of previous heparin drug allergies, bleeding disorders / disorders, alcoholism, or in patients with a history of brain, eye and spinal cord surgery.
