Disseminated intravascular heparin

Contraindications Evidence of active intravascular clotting process, disseminated intravascular coagulation without concurrent heparin therapy, hematuria of upper urinary tract origin (unless benefit outweighs risk) ... 

A 19-year-old man consumed ecstasy for the entire duration of a discotheque party (lasting until morning) and had respiratory difficulty, uncoordinated movements, generalized hypertonia, and hyperpyrexia (40.6°C). The diagnosis was disseminated intravascular coagulation and was treated with heparin but suffered severe blood loss from the oral cavity and injection wounds. He subsequently had a cardiac arrest. 

Thrombotic thrombocytopenic purpura is a rare acute or subacute disease in adults, rather similar to the hemolytic uremic syndrome in children, in which there is systemic malaise, fever, skin purpura, renal failure, hematuria and proteinuria. Hemorrhagic infarcts caused by platelet microthrombi occur in many organs in the brain they may cause stroke-like episodes (Matijevic and Wu 2006) although more commonly there is global encephalopathy. The blood film shows thrombocytopenia, hemolytic anemia and fragmented red cells. The differential diagnosis includes infective endocarditis, idiopathic thrombocytopenia, heparin-induced thrombocytopenia with thrombosis, systemic lupus erythematosus, non-bacterial thrombotic endocarditis and disseminated intravascular coagulation. 

Several inhibitors of plasma origin have been identified as important inhibitors of the coagulation process including antithrombin III (ATIII), protein C, TFPI and heparin cofiictor n. Of these inhibitors, ATIII is fee only agent which has been developed for commercial purposes. Patients wife hereditary thrombophilia due to a classic deficiency of ATin can be treated wife ATTII concentrate. In addition patients wife disseminated intravascular coagulation (DIG), renal insufficiency, post-surgical thrombosis, thermal injury and trauma which are associated with a decrease of ATTII in proportion to the degree of illness/injury, can also be treated (51). 

Cardiogenic shock can occur in parallel with disseminated intravascular coagulation (5). In these circumstances heparin is thought to act as a hapten in a heparin-protein interaction that stimulates antibody production and an antigen-antibody reaction associated with release of platelet and vasoactive compounds. 

Heparin use in patients with disseminated intravascular coagulation may prevent the formation of new blood clots. The most common complication of heparin therapy is bleeding, so some clinicians find it too risky to justify its use. 

Heparin (50(X) to 7500 units IV push) is used in the treatment of pulmonary embolism, in prophylaxis of embolism, in open-heart surgery, in disseminated intravascular coagulation, and in an effort to maintain patency of IV indwelling catheters. 

Thrombosis/embolism, diagnosis and treatment of disseminated intravascular coagulation (DIG), prophylaxis of deep vein thrombosis (DVT), clotting prevention Gearing intermittent infusion lines (heparin lock) to prevent clot formation at site... 

Lepirudin is used for treatment of patients who have thrombosis and thrombocytopenia as a result of an antibody-mediated reaction to heparin (see below). Antithrombin III is used for treatment of patients who need anticoagulation but are resistant to heparin because of a genetic deficiency in antithrombin III and also in some cases of acquired antithrombin III deficiency (eg, disseminated intravascular coagulation). 

Heparin intravenously to a client with disseminated intravascular coagulation. 

Heparin is part of the standard treatment regimen for disseminated intravascular coagulation (DIG). 

The comprehensive review by Douglas provides a recent discussion of the clinically useful anticoagulants. Recent studies have shown heparin to be clearly effective in clinical states In which disseminated Intravascular coagulation was Indicated to be a pathologic factor.75 xhe most commonly employed oral anticoagulants are of the coumarin type such as warfarin and nicoumalone. The oral anticoagulants appear to be of value in the prevention of thromboembolic complications after myocardial infarction.9 76 However, anticoagulation therapy has been found to have no effect on death-rate in these patients.77 Warfarin has been shown to be effective in the prevention of postoperative venous thrombosis. 

Klein, H.G. and Bell, W. R. (1974) Disseminated intravascular coagulation during heparin therapy.intern. Med., 80, 477. 

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