Rev Esp Cardiol
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Hemorrhage is the most common and best-recognized complication of heparin treatment. However, a potentially more dangerous complication is the development of heparin-induced thrombocytopenia (HIT). All patients exposed to heparin, irrespective of the dose and route of administration, are at risk of developing HIT. ⋯ Demonstration of heparin-dependent platelet activation using an antigen or functional assay confirms the clinical diagnosis. Once the diagnosis of HIT has been confirmed serologically or there is a high level of suspicion of HIT, heparin must be suspended and treatment with an alternative anticoagulant should be considered. This review contains a discussion of the diagnosis and treatment of this syndrome.
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Review
[Coronary risk assessment in the management of patients undergoing noncardiac vascular surgery].
Patients scheduled for noncardiac vascular surgery are at significant risk of cardiovascular morbidity and mortality due to underlying symptomatic or asymptomatic coronary artery disease. This review will give an overview of current preoperative cardiac risk assessment strategies for patients undergoing noncardiac vascular surgery. ⋯ Based on these cardiac risk scores further cardiac testing might be warranted in patients at increased risk. Recent developments in laboratory tests, noninvasive cardiac imaging, cardiac stress testing, and invasive cardiac imaging in the preoperative work-up of vascular surgical patients are reviewed.