Prevalence and Clinical Predictors of Heparin Induced Thrombocytopenia

Back Ground: Heparin induced thrombocytopenia (HIT) isthrombocytopenia or thrombosis with one or more positivetests for HIT antibodies. To diagnose HIT, platelet countmonitoring; at least every other day until hospital discharge forday 14 (whichever occurs sooner). A platelet count fall of 50%or greater from baseline or any thrombosis occurs 5 to 10 daysafter heparin starting with exclusion or other causes ofthrombocytopenia are highly suggestive of HIT. Laboratoryconfirming assays are helpful as platelet activations assay.Management of HIT includes discontinuing of any type ofheparin and using an alternative anticoagulant as DTIs(liperudin, argatropan, bivalerudin). Warfarin should be delayedpending substantial recovery of the platelet account.Methods: This study was conducted to 100 patients receivingheparin in a variety of clinical settings to assess the prevalenceof HIT trying to identify clinical predictors of such complication.To all these patients platelet count every other day from baseline to day 14 was done then the 4T score system was appliedto all patients.Results: Only 6 patients developed HIT; 4 of them developedthrombosis and 3 patients died in hospital due to thesethromboembolic events. UFH, surgical treatment and firstheparin exposure were the clinical predictors of HIT.Conclusion: HIT is a serious and life threatening complicationof heparin therapy that should be early diagnosed and properlymanaged to prevent its thromboembolic complications.

Nine months versus 12 months of adjuvant trastuzumab for patients with HER2-positive breast cancer

PURPOSE: This study aimed to compare the results of treatment with adjuvant trastuzumab for 9 months versus 12 months in human epidermal growth factor 2 (HER2)-positive breast cancer patients. The primary endpoint was disease-free survival. Secondary endpoints included cardiac safety, tolerability, and overall survival.METHODS: The study included 60 non-metastatic HER2-positive breast cancer patients. All study patients underwent surgery, received adjuvant chemotherapy, radiotherapy and hormonal therapy if indicated. Thirty patients were randomized in each group. Group I patients received adjuvant trastuzumab for 12 months, while group II patients received adjuvant trastuzumab for 9 months. Patients were assessed by clinical examination and Echocardiography during treatment.RESULTS: After median follow-up of 12 months, 90% of the patients in group I were disease free and 83.3% of patients in group II were disease free (P=0.402). All studied population in both groups I and II were alive at the end of the 1-year follow-up period after the completion of adjuvant trastuzumab treatment thus overall survival is 100%.CONCLUSION: Trastuzumab is tolerable and its side effects are reversible. Nine months of adjuvant trastuzumab treatment is more cost effective than the standard 12 months.