ABSTRACT
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.
ABSTRACT
Back Ground: Chronic Heart Failure is Associated withsecondary hypertension, impaired vascular reactivity andpermeability and reduced alveolar capillary membraneconduction. Sildenafil is a potent and selective inhibitor ofcGMP phosphodiestrase 5 which is responsible for degradationof cGMP, Stabilisation of cGMP result in increasing NO at thetissue level leading to pulmonary vessel vasodilatation.Methods: This study was conducted in Benha UniversityHospital, it included 30 patients with chronic heart failure, theywere divided into two groups, Group (1) was the control groupconsisted of 15 patients and received the standard therapy,Group (2) was the active group consisted of 15 patientsreceived single dose of Sildenafil 50 mg in addition to standardtherapy.Results: In current Study the mean pulmonary artery systolicpressure (PASP) before giving Sildenafil was 58.4 mmhg andafter two hours of use Sildenafil it became 51.7 mmhg. AlsoSildenafil caused significant improvement of peak minuteventilation (VE), peak oxygen uptake (VO2), peak carbondioxide output (VCO2).Conclusion: So Sildenafil is Safe in Stable congestive heartfailure as it reduces pulmonary hypertension, improve exercise