Let's talk about --
a big problem with heparin.
It's heparin-induced thrombocytopenia.
Now, we've got a great diagram for you
there in your downloadable notes.
That really goes into 4 really important steps.
However, remember, we've talked
about real estate in your brain.
I'm not expecting you to remember that in detail.
It's just there if you want
some background information,
and some of us just learn better when we
have that much background information.
It is not the focus.
I just want you to remember, for sure,
that people on heparin can suffer from
So what does that mean?
Well, penia is in your blood,
cyto means cell, and thrombo --
that is low platelets, but look
what happens here in this problem.
HIT, what we call it, type II is a very rare,
but potentially fatal immune-mediated
adverse drug reaction to heparin.
Okay, I said that way too quickly.
I want to slow down the tape
and make sure you get that.
or HIT type II.
It's rare, but when it happens to your patient,
you will never forget it because
they can actually die from this.
It's an immune-mediated adverse
drug reaction to heparin.
So some people who receive heparin develop HIT.
Post-op patients have a higher risk of
developing HIT, so put that on your radar.
That's worth you remembering.
Someone who's had surgery and receives
heparin is at an increased risk
to develop this rare adverse drug reaction.
You want to watch your patients'
platelet count consistently.
is a low platelet count.
So that's part of routine lab
work, keep an eye on that,
particularly if your patient is on heparin.
A very low platelet count, we're
talking about thrombocytopenia,
can start within about 5-10 days of a
patient beginning heparin therapy.
So they've had surgery, they've
been on heparin 5-10 days,
this would be the window of
time and when it might start.
Now, this is the weirdness that happens
in HIT, that these abnormal antibodies
and they develop that attack the
heparin platelet protein complexes.
Okay, that is not a good thing.
Antibodies are part of me.
They're developed to attack
things that I don't want,
but heparin platelet protein complexes are
good things, particularly after surgery.
But this leads to platelet
activation and major clots forming.
So think about that.
You're on heparin, but now we're going to
have heparin-induced thrombocytopenia.
Now we've got this weird platelet
activation, and I have clots everywhere.
This is a dramatic thing to see in your patients.
I had 1 patient, especially was a patient
who had just delivered a child.
It's extremely traumatic to watch
this patient walk through this.
So the patients treated with
have a relatively lower risk to develop this.
So, it's got about 76% in the
probability of developing HIT
compared to patients who
have unfractionated heparin.
So that's another reason that using
the low-molecular-weight heparin
give us a better result and it's a little safer.
So, as nurse Natalie says, and I completely
agree with her, look at that last point.
Your job as a nurse is to watch that
patient's platelet count consistently,
even closer when they are
on unfractionated heparin.
But remember, there are some patients, lower risk,
that might even develop this with
Okay, so we've established that the biggest
complications with HIT are clots, okay?
Not bleeding, our problem is clots.
So make sure you circle that "clots."
You have that solid in your brain that
that's the problem with HIT type II.
So venous clots are what you primarily see.
May also be arterial, but venous
is usually what we see most.
So let's talk about examples of venous clots.
Deep vein thrombosis, like the
one I likely had in my leg.
Pulmonary embolism, which can often be a DVT that
travels up to your lungs, pulmonary embolism.
Skin necrosis, myocardial infarction,
or even venous gangrene.
So, these are examples of where
you can have these clots spread.
Now, you already knew DVT
and pulmonary embolism,
but clots can also break off and go
into little tiny micro vascular.
So that's where you might see the skin necrosis.
Myocardial infarction, that's, again, a clot in the
blood supply to your heart, or venous gangrene.
That means the clot's there in your veins and it
can be like a shower of clots going everywhere.
You'll start to see the patient
really experienced tissue death,
that's what gangrene is going
to be, caused from those clots
because you just don't have
an adequate blood supply.
Okay, we've talked about this test
a little bit in other videos,
but I want to kind of dig down a little
deeper; heparin anti-Xa level blood test.
This is lab work that you'll do and it
indirectly measures the activity of heparin.
Remember, that's one of the
medications we're talking about.
So a heparin anti-Xa level indirectly
measures the activity of heparin,
that its ability to inhibit the
activation of factor X or Xa.
So this test is another test in our
toolkit that we can use with heparin.
We often use it with unfractionated heparin,
but you can also use it with low-molecular-weight
heparin, so it's a newer test for us.
So make sure you familiarize
yourself with the name of it,
and just that it gives us an
indication of the activity of heparin.
Now, let me share some of
the normal values with you.
These are therapeutic levels.
Now, there's a difference
between normal and therapeutic.
When we're talking about a therapeutic level,
that means this level should be a little
different than what it would be in a body
that was not receiving this medication.
So, for a patient receiving
here's an example of what a
therapeutic level would be.
Now, I know in nursing school, sometimes
students get really frustrated,
because it seems like every textbook has
a different level and a different range.
I understand that, and that's actually true.
But you're going to experience that in real life.
Every lab has a little bit different normal
reference range or therapeutic range.
Every lab will tell you what
their normal levels are,
and you can just compare your
patient values with that.
For nursing school, that's something
you'll need to negotiate with your faculty
to know what level they're accepting.
But in real life, whatever lab the work is drawn at,
you will see the normals
posted right with the results.
Okay, so back to our example results.
Unfractionated heparin was at the top.
You see the level for it,
You notice there's a little difference for those.
Now, low-molecular-weight heparin, if they
have it twice daily, there's 1 range.
If they have it once daily, there's a
different range just to give you an idea.
So, what I'm asking is that you not memorize
these, you just know that they're out there
and know that the values that are therapeutic
will be different based on the medication.
And you see I've 1 more medication
at the end, but keep in mind,
I'm not asking you to memorize these values.
I'm asking you to be aware that this helps
us understand the activity of heparin,
and there are ranges out there that tell us
when this particular medication
is in a therapeutic range.
That's the biggest takeaway
points on these slides.