Assessment of Adherence to Cardiovascular Medicines in Saudi Population: An Observational Study in Patients Attending a Tertiary Care Hospital.

BACKGROUND: Drug adherence has been extensively evaluated in many developed countries in the West using different methods of medication adherence measurement; however, there are relatively few reports studying the adherence levels among Saudi patients. Thus, this study will evaluate the adherence to cardiovascular medicines in Saudi patients visiting (PSCC) in Al-Qassim, Saudi Arabia. METHODS: This cross-sectional observational study relied on self-administered questionnaires. This study used the Morisky, Green, and Levine (MGL) Adherence Scale, also known as the MAQ (Medication Adherence Questionnaire), in PSCC's pharmacy waiting room in Qassim, Saudi Arabia. RESULTS: This study included 993 PSCC pharmacy waiting room patients. The patients were between 11 and 50 years old, and 52.7 percent were male. Most participants (71.2%) were above 50, while 16.3% were 41-50. Non-adherent patients cited traveling or being busy (28.6%), forgetting (18.7%), daily multi-medications (7.1%), being sleepy or sleeping (6.6%), and not repeating the prescription (6.6%). The Medicine Adherence Questionnaire indicated that 62.6 percent of patients fully adhered to their medications, and 21.6 percent usually adhered. Only drug adverse effects affected adherence (p =0.0001). CONCLUSION: The current study showed that there is a good level of adherence among patients with cardiovascular diseases toward their diseases. The most common reasons for neglecting medications include traveling or being busy, forgetting multiple medications, and being tired or sleeping. Having experience with side effects was the only significant factor affecting adherence to medications.

Comparison between the ECG Outcomes of Metoprolol and Bisoprolol.

BACKGROUND: Beta-blockers are essential agents in the management of cardiovascular diseases, such as heart failure, acute myocardial infarction (MI), and cardiac arrhythmias. However, there are diurnal variations in the cardioprotective effects of the subgroups as a result of their different pharmacokinetic, pharmacodynamic, and pharmacogenetic profiles. OBJECTIVE: We aimed to compare metoprolol and bisoprolol in terms of electrocardiogram (ECG) outcomes. METHODS: A retrospective cross-sectional study was conducted at Prince Sultan Cardiac Center. The trial included 404 patients who met the inclusion criteria (204 in the metoprolol arm and 200 in the bisoprolol arm). Using case record forms that had already been created, information, such as patient demographics, medical histories, and treatment histories, was taken from their medical files. The most recent ECG records were also gathered. The ethical approval for this study was obtained from Qassim ethical committee (approval number: 45-44-902). RESULTS: There was no significant difference found between the patients in both arms in terms of baseline characteristics, age, or sex. CONCLUSION: In this retrospective cross-sectional study, we have compared the effects of metoprolol and bisoprolol beta blockers on ECG changes. The findings have indicated no difference between metoprolol and bisoprolol groups in terms of all ECG readings, particularly PR/ms, QTC-ms, and ventricular rate. Further studies are required to confirm these findings.

Holmium Laser Xpeeda Vaporization vs GreenLight XPS Vaporization of the Prostate for Benign Prostatic Obstruction: 1-Year Results from a Randomized Controlled Clinical Study.

Introduction and Objective: To compare the safety and efficacy of Holmium Laser Xpeeda Vaporization and GreenLight XPS Vaporization of the prostate in patients with prostate size ≤80 g. Methods: Ninety-two men with benign prostatic hyperplasia (BPH) and prostate size ≤80 g scheduled for laser prostatectomy were included in this prospective randomized trial. Outcome measures were collected and compared, including International Prostate Symptom Score (IPSS), quality of life (QoL), flow rate, postvoid residual urine volume (PVR), International Index of Erectile Dysfunction (IIEF)-15, prostate-specific antigen (PSA), transrectal ultrasound prostate volume, and catheterization time. Perioperative complications were also recorded. Patients were offered a trial of void (TOV) 3 hours after their procedures. All patients were followed-up at 1, 3, 6, and 12 months. Results: There were no significant differences in preoperative baseline data between the two surgical groups. Operative parameters and postoperative outcomes were comparable. Effective same-day TOV was noted in 73.1% and 72.7% of the Xpeeda and GreenLight XPS patients, respectively (p = 0.98). All patients were discharged home within 24 hours of their surgeries. The laser energy and postoperative complications were significantly lower in the Xpeeda group (p = 0.002 and p = 0.026, respectively). At 3 months, the PSA levels significantly dropped in both groups (p = 0.002 and p < 0.001). There were no significant differences in functional and sexual outcomes between the two groups at 12 months. Conclusions: Holmium Laser Xpeeda Vaporization and GreenLight XPS Vaporization are safe and effective in the treatment of BPH. Same-day discharge with early TOV is a feasible option. Clinical Trials.gov Identifier: NCT04386941.

Outcomes of Top-Down Holmium Laser Enucleation of Prostate for Recurrent/Residual Benign Prostatic Hyperplasia: One-Year Follow-Up.

Materials and Methods: We carried out a retrospective analysis of patients who underwent top-down HoLEP for the management of recurrent BPH at our institution. Patients who had previously undergone TURP were assigned to group I, while those with no history of prostate surgery were allocated to group II. Preoperative clinical characteristics, enucleation time, resected tissue weight, morcellation time, energy used, and intraoperative and postoperative complications were recorded and statistically analyzed. Patients were followed up postoperatively at 1, 3, 6, and 12 months. The evaluation included the International Prostate Symptom Score (IPSS), quality of life assessment (QoL), maximum urinary flow rate (Q max), postvoid residual urine test (PVR), and continence status. Results: Two hundred and sixty-nine patients were included in this study. Group I consisted of 68 patients with recurrent BPH, while group II included 201 patients. There were no statistically significant differences in preoperative characteristics between both groups. The median enucleation time for group I (67.5 min (25-200)) was not significantly longer than that for group II (60 min (19-165) (p=0.25)). Operative outcomes, including morcellation time, resected weight, catheter duration, and hospital stay, were comparable between both groups. At 1, 3, 6, and 12 months, all urinary functional outcomes showed significant improvement, and there were no significant differences between the two groups. At 3 months' follow-up, two patients in group I and three patients in group II experienced stress urinary incontinence (SUI). At the last follow-up visit, one patient from group I presented with persistent SUI. Conclusions: For managing recurrent and nonrecurrent cases of BPH, top-down HoLEP is safe with comparable urinary functional outcomes. Patients with a history of previous prostate surgery can be counselled that their prior transurethral procedure does not reduce the benefits of HoLEP.

Factors Predicting Successful Same-Day Trial of Void (TOV) After Laser Vaporization of the Prostate.

OBJECTIVE: To determine the safety and efficacy of same-day urethral catheter removal after laser vaporization of the prostate and to identify factors contributing to a successful trial of void (TOV). METHODS: We conducted a retrospective analysis of 98 patients who underwent laser vaporization of the prostate using GreenLight or Holmium Xpeeda laser fibers from April 2018 to March 2021. All patients included in the study were offered a same-day TOV and had their catheters removed 3 hours postoperatively. Patient demographics, intraoperative parameters, and postoperative outcomes were collected and analyzed. Patients who were medically unfit or those on antiplatelet or anticoagulant medications were excluded. Multivariate logistic regression analyses were used to determine potential predictors of a failed TOV. RESULTS: The median age of included patients was 69 years (56-86) with a prostate size of 54 grams (40-78.4). The median operative time was 50 minute (20-93). 72 patients (73.5%) had a successful TOV without the need for urethral catheter reinsertion. The median hospital stay for patients was 5 hours. Preoperative post-void residual (PVR) urine was the only predictor of a successful TOV on both univariate and multivariate logistic regression analyses. CONCLUSION: Same-day catheter removal following laser vaporization of the prostate is a feasible option with a 73.5% success rate.

Pulsed fluoroscopy in retrograde urethrograms.

OBJECTIVES: Retrograde urethrogram (RUG) is one of the corner stones for the reconstructive urologist. With hundreds of RUGs being performed yearly in busy reconstructive center, the concern for radiation exposure to the patient and the medical personnel becomes important. We propose the use of pulsed fluoroscopy to decrease the radiation exposure for patient and medical personnel. METHODS: Patients presenting to our center with urethral strictures between March 2016 and March 2019 were included in our study. The fluoroscopy machine was set for pulsed fluoroscopy at a setting of 4 pulses per second. Patient information including demographics, pre-operative diagnosis, Intra-op findings, and fluoroscopy time were recorded. RUG was performed to localize the stricture pre-operatively and post-operatively. RESULTS: A total of 185 RUG were performed between March 2016 and March 2019. The median age was 63 (14-81). The remaining 154 RUG had 77 performed pre-operatively and 77 performed post-operatively. Pathology was identified in 77 patients. Intra-operative confirmation of pre-operative finding was found in 76 patients (98.7%). Median fluoroscopy time was found to be 2.43 seconds (0.5 sec- 6.5 sec). CONCLUSIONS: Pulsed fluoroscopy reduces the radiation exposure in RUG without a reduction in the diagnostic capacity of the test. Reduction of fluoroscopy can have beneficial cumulative effect as per the ALARA principle for patients and medical personnel. Further studies with randomized control trials could be of great benefit.

Miniaturized Ambulatory Percutaneous Nephrolithotomy Versus Flexible Ureteroscopy in the Management of Lower Calyceal Renal Stones 10-20 mm: A Propensity Score Matching Analysis.

OBJECTIVE: To evaluate the efficacy of ambulatory mini percutaneous nephrolithotomy (Mini-PCNL) and flexible ureteroscope (F-URS) in treating 10-20 mm lower calyceal stones using propensity score matching analysis (PSM). PATIENTS AND METHODS: A retrospective analysis of 136 adult patients that underwent Mini-PCNL or F-URS for a single lower calyx calculus. Participants that underwent F-URS were allocated to Group I, while those who underwent Mini-PCNL were assigned to Group II. Patients were discharged on the same day and followed up by CT after 3 months. Both groups were matched by stone size and density using propensity stone matching (PSM) and the matched group were further compared. RESULTS: Before matching, there were statistical differences in stone size (P = .02), preoperative hydronephrosis (P = .004), and Hounsfield Unit (P = .04) between both groups. A logistic regression model was created between independent variables such as stone size and density. The new groups following PSM were statistically similar in terms of age, BMI, stone size, and HFU (P = .43, P = .74, P = .49, P = .36). The stone-free rates after PSM was not significantly higher in the Mini-PCNL group than the F-URS group (91.7% vs 81.7%, respectively P = .1) while the operative time for the F-URS group was significantly shorter than the Mini-PCNL group 54 (49-64.3) minutes vs 68.2 (62-73.5) minutes, respectively, P = .045. CONCLUSION: Ambulatory Mini-PCNL and F-URS have a comparable hospital stay, stone-free rates, and complication rates for treating lower calyceal stones 10-20 mm. Both techniques may be considered acceptable treatment options, with a prolonged operative time in Mini-PCNL.

Evaluation of acute flaccid paralysis surveillance indicators in Sokoto state, Nigeria, 2012-2019: a secondary data analysis.

BACKGROUND: Nigeria, the last endemic country in the WHO African Region, was certified free of Wild Polio Virus (WPV) in 2020. However, due to low immunity in some communities in Sokoto, outbreaks of the circulating Vaccine Derived Polio Virus (cVDPV) occur. The aim of this study is to evaluate the Acute Flaccid Paralysis (AFP) surveillance indicators in Sokoto state, Nigeria. METHODS: This retrospective study was an analysis of routinely collected AFP surveillance data between 2012 and 2019 by the Sokoto state surveillance network. We assessed the Sokoto state AFP surveillance system using the AFP surveillance performance indicators. We performed all analyses using Microsoft Excel 2019. RESULTS: Cumulatively, 3001 Acute Flaccid Paralysis (AFP) cases were reported over the evaluation period, out of which 1692 (56.4%) were males, and 2478 (82.4%) were below five years. More than half, 1773 (59.1%), had a fever at the beginning of the disease, and 1911 (63.7%) had asymmetric paralysis. The non-polio AFP rate (9.1 to 23.5% per 100,000 children < 15 years old) and stool adequacy rate (92.5 to 100%) indicate high sensitivity. The proportion of cases that had stool samples collected early, timely transported to the laboratory and arrived at the laboratory in optimal condition were all above the World Health Organization (WHO) minimum standard of 80%. There was inadequate profile documentation of some suspected cases. CONCLUSIONS: Sokoto State has exceeded the WHO minimum standards in most of the AFP surveillance indicators. The performance of the system is sufficient enough to detect any reintroduction of WPV into the state. However, there is a need for improvement in data quality.

Impact of case volume per year on flexible Ureteroscopy practice: an internet based survey.

BACKGROUND: To report current worldwide variation in techniques and clinical practice of flexible ureteroscopy (FURS) among endourologists of different case volumes per year. METHODS: Two invitations to complete an internet survey were emailed to Endourological Society members. Some of survey questions asked about indications of using FURS for renal and upper ureteral stones. Others were concerned with clinical practice of FURS (such as preoperative stenting, use of ureteral access sheath (UAS) and safety guidewire, technique of Laser lithotripsy and fragment retrieval, and post-FURS stenting. Responders were distributed into two groups; high-volume (> 100 cases/year) and low-volume surgeons (< 100 cases/year) and data were compared between both groups. RESULTS: Responses were received from 146 endourologists all over the world (62 high-volume and 84 low-volume). FURS for intrarenal stone > 20 mm was used by 61% of high-volume surgeons compared with 28.6% for low-volume (P < 0.001). Semirigid URS was used for upper ureteric stones in 68% among high-volume group and 82% in low-volume group (P = 0.044). UAS was used by 62% in low-volume group and 69% in high volume group (P = 0.516). Laser stone dusting was preferred by 63% in low-volume group versus 45% by high-volume (P = 0.031). More responders in low-volume group preferred to leave the stent for 6 weeks (P = 0.042). CONCLUSIONS: The use of FURS for treating upper tract calculi has expanded by high volume endourologists to include large renal stones > 20 mm. Low-volume surgeons prefer to use semi-rigid URS for treatment of upper ureteral stones, to apply Laser stone dusting and maintain ureteral stents for longer periods.

Awareness of carpal tunnel syndrome among adult population of Al Majmaah city, Saudi Arabia, 2018-2019.

BACKGROUND: Due to the lack of data and studies concerning about measurement of population awareness about carpal tunnel syndrome (CTS) in Al Majmaah city, this study aims at determining the level of population awareness among Al Majmaah adult population in Saudi Arabia. AIMS: To study the awareness of CTS among adult population in Al Majmaah city, Saudi Arabia, and to estimate the overall prevalence of CTS. In addition, to look for the relationship between CTS and chronic disease. MATERIALS AND METHODS: In this cross-sectional study, 386 individuals were covered, both males and females in the targeted areas. A standardized questionnaire was used to cover 11 different aspects concerning CTS. SPSS package was used to analyze the data collected from the sample. RESULTS: The result of scoring system shows that 54 of participants (14.0%) have CTS. Approximately, 30% of them are thought that the main symptom is pain in wrist. However, 26.7% think that tingling and numbness in fingers is the main manifestation. The most causes that population think that leads to the CTS are trauma, repeated hand physical activities such as using computer, taping, and wrist fracture or dislocation by 33.8%, 29.1%, and 21.4% respectively. There is relationship between patients who had chronic diseases and CTS [sig = 0.000]. CTS cause a strong effect on social life by 79.01% of participant though that CTS could affect patient sleep and job performance. CONCLUSION: The awareness of community was sufficient among adult population in Al Majmaah city, and the prevalence of CTS is 14%.

Comparison of the Effects of Metoprolol and Bisoprolol on Lipid and Glucose Profiles in Cardiovascular Patients.

BACKGROUND: Cardioselective beta-blockers may affect glucose or lipid profiles. OBJECTIVE: We sought to compare the effects of two beta-blockers, metoprolol and bisoprolol, as the most commonly used drugs in cardiology, on glucose and lipid profiles in patients with cardiovascular diseases. METHODS: We conducted a retrospective cross-sectional matched study at Prince Sultan Cardiac Center in Burydah in August 2017. Patient records were screened, and adult patients with cardiovascular disorders who were treated with a stable dose of metoprolol or bisoprolol were included. Parameters related to glucose and lipid metabolism were compared using the Student's t-test between the two groups. RESULTS AND CONCLUSION: The metoprolol and bisoprolol arms included 204 and 200 patients, respectively.

A Rare Case of Multiorgan Calciphylaxis in a Patient with Stage 5 Chronic Kidney Disease.

Calciphylaxis or calcific uremic arteriolopathy (CUA) is a potentially life-threatening vasculopathy involving the skin and subcutaneous tissues. It is usually associated with chronic kidney disease (CKD) and rarely with acute renal failure or predialysis patients. The clinical diagnosis of calcific uremic arteriolopathy relies on high index of suspicion. CUA is commonly associated with secondary hyperparathyroidism and high serum calcium and phosphate products. Moreover, using biopsy as a diagnostic tool is controversial, due to the high risk of poor wound healing and sepsis. Radiological studies usually reveal extensive calcification of branching vessels such as penile arteries, eventually leading to gangrene formation in extremities and penis. Histopathological analysis confirms the diagnosis of calcific uremic arteriolopathy and rules out the presence of malignancy. CUA is a systematic disease that involves multiple organs, and to the best of our knowledge this is the first reported case involving the penis, bladder, and eyes.

Adult Intussusception.

Adult intussusception is rare. We report the case of an elderly female patient with an ileocecal intussusception who underwent resection and ileocolic anastomosis. The histology revealed chronic inflammation of the ileum and cecum and there was no evidence of malignancy. There was no evidence of malignancy. The appendix showed fibrous obliteration of the lumen.

CYP2B6 and OPRM1 Receptor Polymorphisms at Methadone Clinics And Novel OPRM1 Haplotypes: A Cross-Sectional Study.

INTRODUCTION: Methadone is accepted as an alternative therapy in opioid use disorders worldwide. Methadone responsiveness, however, is affected by a range of CYP450 enzymes and OPRM1 polymorphisms. OBJECTIVE: This study sought to detect CYP2B6 and OPRM1 variants and their genotypes, as major contributors to inter-variability in methadone responsiveness and methadone dose requirements. METHODS: We carried out a prospective experimental one-phase pharmacogenetic study in four addiction clinics in Malaysia. Patients on stable methadone maintenance therapy were recruited. The prevalence of the CYP2B6 and OPRM1 polymorphisms was determined using a nested polymerase chain reaction (PCR), followed by genotyping. A two-step multiplex PCR method was developed to simultaneously detect the 26 SNPs in these two genes. RESULTS: 120 males were recruited for this study. The patients were between 21and 59 years old, although the majority of the patients were in their 30s. C64T and G15631T in CYP2B6and G31A, G691C, and A118G in OPRM1 were found to be polymorphic, and the allelic frequencies of each were calculated. We further detected eight new haplotypes. CONCLUSION: C64T and G15631T in CYP2B6and G31A, G691C, and A118G in OPRM1were found to be polymorphic. The new haplotypes may give a new insight on methadone clinics.

Factors associated with knowledge, attitude and practice related to hepatitis B and C among international students of Universiti Putra Malaysia.

BACKGROUND: Knowledge of hepatitis B and C has been reported to be low among respondents in different studies. We conducted a cross-sectional study among international students of Universiti Putra Malaysia (UPM) to ascertain their levels of knowledge, attitude and practices regarding hepatitis B and C and its associated factors. METHODS: Six hundred and sixty two (662) international students participated in this study. A cluster sampling method was employed and data was generated using self-administered questionnaire, which was validated and its reliability checked. RESULTS: Normality test was conducted followed by descriptive statistics, spearman's correlation and Chi-square tests to explore associations between variables in the study. The response rate was 71.49 %. Of these, 50.3 % of the respondents had better knowledge of hepatitis B; 52.7 % had better knowledge of hepatitis C; 54.8 % had positive attitude towards hepatitis B and C and 77.6 % had safer practices towards hepatitis B and C. Positive correlations were found between knowledge of hepatitis B and knowledge of hepatitis C; knowledge hepatitis B and attitude; knowledge hepatitis C and attitude; knowledge hepatitis B and practice; knowledge hepatitis C and practice; and attitude and practice regarding hepatitis B and C. Similarly, some socio-demographic variables and history of hepatitis were found to be associated with knowledge, attitude and practice related to hepatitis B and C. CONCLUSION: The levels of knowledge and attitude towards hepatitis B and C were low among respondents but majority of them exhibited safe practices. The study level, faculty, age, nationality, marital status and gender of the respondents were significantly associated with their levels of knowledge, attitude and practices towards the disease. These findings imply that there is need for hepatitis health promotion among the international students of UPM and possibly other international students across the globe. It will serve to improve their levels of knowledge, attitude and practices in short term and get them protected against the disease in the long run.

Impact of Cytochrome P450 2C19*2 and *3 on Clopidogrel Loading Dose in Saudi Patients with Acute Coronary Syndrome.

BACKGROUND: Emerging evidence shows that clopidogrel is greatly affected by nonfunctioning alleles measured by P2Y12 or platelet reactivity units (PRU). Cardiac events during short in-hospital stays have been inconclusively suggested as the main causes of discrepancies. OBJECTIVES: Evaluate the impact of CYP2C19 allele *2 and allele *3 on PRU and the potential clinical consequences of such interaction. To establish a rough estimation for the safe PRU limits for short inhospital stay following PCI. METHOD: A short-term experimental study was conducted with 90 patients who underwent coronary angioplasty with drug eluting stents at the Prince Sultan Cardiac Center, Buraidah. All the patients received an initial loading dose of 300 mg clopidogrel, followed by 75 mg daily. Blood samples were used for DNA extraction for cytochrome P450 (CYP) and realtime polymerase chain reaction (PCR) was used for genotyping. PRU and inhibition rate were tested by Verifynow®. All in-hospital cardiac events were recorded until patients were discharged. RESULTS: Genotypes 1/1, 2/2, and 1/2 were expressed by 60, 28, and two patients (67, 32, and 3%), respectively. The PRU of the female patients was significantly higher than that of the male patients was (255.6 ± 68.8 and 177.7 ± 66.6, p = 0.000, respectively). There was no significant difference in PRUs (193 ± 79 and 212 ±55.4, respectively, p = 0.349), nor inhibition (17.9 ± 18.80 and 13.88 ± 11.5, p = 0.135) in wild and resistant variants, respectively. We only reported one cardiac in-thrombosis events. CONCLUSION: Genotype differences may not explain variations in the PRU of patients during short-term in-hospital stays. Although it is difficult to confirm, 117-267 units may be a safe PRU range for such patients, with emphasis on attaining higher PRU values in females.

The Pharmacotherapy of Heparin-Induced Thrombocytopenia (HIT) : A Review of Contemporary Therapeutic Challenges in Clinical Practice.

Our objectives were to discuss a general overview on the description and recognition of heparin-induced thrombocytopenia (HIT) and present a critical review of the traditional and most recent advances in its pharmacotherapy. Computerized searches were done on MEDLINE and Iowa Drug Information Service (IDIS) databases from June 2001 until June 2007 and from May 2005 until May 2007, respectively. Search terms used included 'heparin-induced thrombocytopenia', 'heparin-associated thrombocytopenia', therapeutics, HIT, HAT. We largely selected publications within the timeframe above, but did not exclude commonly referenced and highly regarded older publications. The commonly referenced published articles were obtained through manual searches derived from bibliographic citations and retrievals from the authors' personal files. Pertinent literatures (89 key articles) that were thought to have substantially contributed new information to the therapeutics of HIT within the last 6 years were identified, reviewed and presented. The following limits were used for the MEDLINE and IDIS searches: 'human', drug therapy', 'review', 'meta-analysis', 'clinical trial', and case reports. The therapeutics of HIT is rapidly evolving and needs to consider an evidence - based approach. It is imperative that practitioners be aware of the associated risk and be up-to-date with the current advances in the management of this fatal clinical condition.

The pharmacotherapy of heparin-induced thrombocytopenia (HIT): A review of contemporary therapeutic challenges in clinical practice

Our objectives were to discuss a general overview on the description and recognition of heparin–induced thrombocytopenia (HIT) and present a critical review of the traditional and most recent advances in its pharmacotherapy. Computerized searches were done on MEDLINE and Iowa Drug Information Service (IDIS) databases from June 2001 until June 2007 and from May 2005 until May 2007, respectively. Search terms used included ‘heparin-induced thrombocytopenia’, ‘heparin-associated thrombocytopenia’, therapeutics, HIT, HAT. We largely selected publications within the timeframe above, but did not exclude commonly referenced and highly regarded older publications. The commonly referenced published articles were obtained through manual searches derived from bibliographic citations and retrievals from the authors’ personal files. Pertinent literatures (89 key articles) that were thought to have substantially contributed new information to the therapeutics of HIT within the last 6 years were identified, reviewed and presented. The following limits were used for the MEDLINE and IDIS searches: ‘human’, drug therapy’, ‘review’, ‘meta-analysis’, ‘clinical trial’, and case reports. The therapeutics of HIT is rapidly evolving and needs to consider an evidence – based approach. It is imperative that practitioners be aware of the associated risk and be up-to-date with the current advances in the management of this fatal clinical condition.