Friday, March 09, 2007
Xigris and platelets
Yesterday I got consulted on this 63 y/o woman with abdominal sepsis: she had been on chronic prednisone for SLE and presented with perforated colon diverticuli with peritonitis. She has developed mild renal failure (creat up to 2.4 from 1.5), resp. failure (PaO2/FiO2 ~80) and is still requiring pressors after VERY vigorous fluid replacement. She had good post-op hemostasis and platelets around 100K. In addition to the usual care (ABTx, vent, etc). We started her on Xigris. ~8 hours into it her platelets dropped to ~10K. We held the Xigris and this am they are 26K. Would you continue to hold it, monitor and resume it, transfuse platelets and resume it or just forget about Xigris in her?
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5 comments - CLICK HERE to read & add your own!:
What is her APACHE2 score before and after Xigris?
Do you think Xigris causing thrombocytopenia or something else such as DIC, meds (heparin, vancomycin) etc?
Cut off of plt used in PROWESS was 30K if I am not mistaken.
Tough one. I would probably not have started Xigris on such a patient as recent surgery was an exclusionary criteria in PROWESS. But...with the platelet drop of 10K I would defintely hold further Xigris infusion.
Actually surgery within 12 hours was an exclusion in PROWESS.
26% of patients in the treatment group had had recent surgery (20.7% were actually s/p recent emergent surgery).
I agree that in PROWESS, the subgroup analysis showed less benefit for surgical patients. Our initial thinking was that hemostasis was adequate, there were no other absolute contra-indications and despite vigorous resuscitation, she was still in shock with at least 2 organs failing and should be tried on it...
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