1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
|
-- ==============================================================
-- GNUmed database schema change script
--
-- License: GPL v2 or later
-- Author: Karsten Hilbert
--
-- ==============================================================
\set ON_ERROR_STOP 1
--set default_transaction_read_only to off;
-- --------------------------------------------------------------
delete from ref.keyword_expansion where keyword = 'algo-HIT';
insert into ref.keyword_expansion (
fk_staff,
keyword,
textual_data
) values (
null,
'algo-HIT',
'HIT risk assessment
-----------------------------------------------------------
Chest / 141 / 2 / February, 212 Supplement / e499S
"Treatment and Prevention of Heparin-Induced Thrombocytopenia"
Indication: $[indication for Hep/LMWH]$
Exposure >4d: $[>4d exposure: Yes/No]$
Substance: $[name of Hep/LWMH]$
HIT risk in postoperative patients:
1-5% -- Heparin, any dose
0.1-1% -- Heparin, flushes (case reports only)
0.1-1% -- LMWH, any dose
1-3% -- cardiac surgery (?Heparin)
HIT risk in non-surgical patients:
1% -- cancer (?Heparin)
0.1-1% -- Heparin, any dose
<0.1% -- Heparin, flushes
0.6% -- LMWH, any dose
0.4% -- ICU (?Heparin)
<0.1% -- Obstetrics (?Heparin)
(risk of HIT from Heparin generally 10x that of HIT from LMWH)
Risk estimate: $[risk estimate]$
If risk > 1% platelet monitoring every 2-3 days from
day 4 to day 14 or until exposure stops is suggested.
No monitoring is suggested if the risk is < 1%.
Monitor: $[Monitor ? Yes/No]$
Diagnostic hints:
typically at 5-10 days after begin of exposure platelets fall to
< 150x10^9/l
(occurs in 85-90% of patients developing HIT)
or to
30-50% of pre-exposure value even if > 150x10^9/l
(occurs in 90-95% of patients developing HIT)
');
-- --------------------------------------------------------------
select gm.log_script_insertion('v21-HIT_risk.sql', '21.0');
|
