Practical-Manual-Scores-Algorithms-Haemostasis-Thrombosis

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Anticoagulant therapyInterpretationAccording to the 4T rule, 3 levels of clinical probability can be defined:• High = 6-8 points• Intermediate = 4-5 points• Low = ≤ 3 pointsOnce the pre-test probabilities are assumed, the HIT diagnostic / therapeuticalgorithm can proceed.Thrombocytopenia in a patientreceiving heparin or LMWHApply clinical scoring systemHigh clinical suspicion(4T’s = 6-8)Discontinue heparin:start alternative therapyImmunoassayIntermediate (4T’s = 4-5)Discontinue heparin:start alternative therapyImmunoassayLow clinicalsuspicionfor HIT(4T’s ≤ 3)Continueheparin therapyPositive HITconfirmed(post-test probabilityof HIT > 95%)Negative HITHIT unlikely(post-test probabilityof HIT~ 3-16%)Positive HITpossible(post-test probabilityof HIT ~ 60%)Negative HITHIT unlikely(post-test probabilityof HIT< 0,5%)ConsiderfunctionalassayPresence ofhigh IgG OD/titerand/or plateletactivating antibodiesincrease HIT likelihood(post-test probability of HIT ~ 65%)Presence oflow IgG OD/titeror lack plateletactivating antibodiesdecrease HIT likelihood(post-test probability of HIT ~ 40%)References• Crowther MA, Cook DJ, Albert M, et al.; Canadian Critical Care Trials Group. The4Ts scoring system for heparin-induced thrombocytopenia in medical-surgicalintensive care unit patients. J Crit Care. 2010;25:287-93.• Greinacher A. Heparin-induced thrombocytopenia. J Thromb Haemost.2009;7(Suppl 1):9-12.• Warkentin TE. How I diagnose and manage HIT. Hematology Am Soc HematolEduc Program. 2011:143-9.• Warkentin TE, Greinacher A, Koster A, et al.; American College of ChestPhysicians. Treatment and prevention of heparin-induced thrombocytopenia:American College of Chest Physicians Evidence-Based Clinical Practice Guidelines(8th edition). Chest 2008;133(Suppl 6):340S-380S.60
Bridging strategies in patients on anticoagulantswho need to undergo invasive proceduresIndicationFor patients on vitamin K antagonists requiring a surgical or invasiveprocedure, the question of whether or not to bridge and how to bridge iscommonly encountered in clinical practice.Anticoagulant therapyRisk assessment of thrombosisArterial thrombosisHigh • Atrial fibrillation with CHADS 2score: 4-6• Atrial fibrillation and rheumatic heart valve disease• Mechanical mitral valve prosthesis• Recently inserted heart valve prosthesis• Heart valve prosthesis plus additional thrombotic risk• Old type mechanical heart valve (caged ball, tilting disk)• Intracardial thrombosisIntermediate • Atrial fibrillation with CHADS 2score: 2-3• Mechanical aortic heart valve without any other risk• Recurrent TIA• Ischemic brain infarct without cardiac embolismLow • Atrial fibrillation with CHADS 2score: 0-1• Cerebrovascular disease without recurrent TIA/infarctionVenous thromboembolismHigh• Recent (< 3 months) venous thromboembolism• Thromboembolism with known thrombophilia• Recurrent idiopathic venous thromboembolismIntermediate Venous thromboembolism 3-6 months agoLowVenous thromboembolism > 6 months ago61
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Practical manualScores and Algorith
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Scientific boardHenri BounameauxDiv
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SummaryBleedingISTH bleeding assess
Page 9 and 10: Clinical probability model for deep
Page 11 and 12: FeatureGeneva scoresPoints(revised
Page 13 and 14: InterpretationClinical decision rul
Page 15 and 16: 6 features with a similar validity.
Page 17 and 18: Prediction of recurrent deep vein T
Page 19 and 20: Outpatient versus inpatient care in
Page 21 and 22: Assessment of post-thrombotic syndr
Page 23 and 24: Diagnostic algorithm in suspected p
Page 25 and 26: Prediction of stroke risk in patien
Page 27 and 28: References• Camm AJ, Lip GY, De C
Page 29 and 30: References• Friberg L, Rosenqvist
Page 31 and 32: InterpretationThis score identifies
Page 33 and 34: Vienna score (Ay Model): DVT or PE
Page 35 and 36: Risk assessment modelsin hospitaliz
Page 37 and 38: References• Chopard P, Spirk D, B
Page 39 and 40: Recommendations for the determinati
Page 41 and 42: Template for scoring system for non
Page 43 and 44: Diagnosis of Thrombotic Thrombocyto
Page 45 and 46: Management of patientswith occlusio
Page 47 and 48: Symptoms(up to the time of diagnosi
Page 49 and 50: InterpretationA bleeding score > 3
Page 51 and 52: Pediatric Bleeding scoreSymptoms Sc
Page 53 and 54: Bleeding assessment tool for the ev
Page 55 and 56: The SMOG system (cont.)Type of blee
Page 57 and 58: The SMOG system (cont.)Type of blee
Page 59: Diagnostic and therapeutic algorith
Page 64: Practical manualof scores and algor
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Practical-Manual-Scores-Algorithms-Haemostasis-Thrombosis

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