Download PDF
Semin intervent Radiol 2017; 34(04): 409-414
DOI: 10.1055/s-0037-1608864
Clinical Corner
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Heparin-Induced Thrombocytopenia and Thrombosis: Preventing your Thrombolysis Practice from Taking a HITT

Eric Wannamaker
1   Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
,
Kimi Kondo
1   Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
,
D. Thor Johnson
1   Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
› Author Affiliations
Further Information

Publication History

Publication Date:
14 December 2017 (online)

Also available at
    Permissions and Reprints

Abstract

Heparin-induced thrombocytopenia and thrombosis (HITT) is an under-recognized cause of deep venous thrombosis treatment failure and of complications during catheter-directed thrombolysis. After a review of HITT pathophysiology, diagnosis, and management, three different cases are presented in this article. Each case highlights subtleties and challenges of HITT diagnosis and management. An example of a practical approach to the diagnosis of HITT is presented.

Keywords

HITT - venous thrombosis - catheter-directed thrombolysis - interventional radiology - hypercoagulability workup
 

  • References

  • 1 Chong BH. Heparin-induced thrombocytopenia. J Thromb Haemost 2003; 1 (07) 1471-1478
    CrossrefPubMedSearch in Google Scholar
  • 2 Ahmed I, Majeed A, Powell R. Heparin induced thrombocytopenia: diagnosis and management update. Postgrad Med J 2007; 83 (983) 575-582
    CrossrefPubMedSearch in Google Scholar
  • 3 Gupta S, Tiruvoipati R, Green C, Botha J, Tran H. Heparin induced thrombocytopenia in critically ill: diagnostic dilemmas and management conundrums. World J Crit Care Med 2015; 4 (03) 202-212
    PubMedSearch in Google Scholar
  • 4 Shaikh N. Heparin-induced thrombocytopenia. J Emerg Trauma Shock 2011; 4 (01) 97-102
    CrossrefPubMedSearch in Google Scholar
  • 5 Levy JH, Hursting MJ. Heparin-induced thrombocytopenia, a prothrombotic disease. Hematol Oncol Clin North Am 2007; 21 (01) 65-88
    CrossrefPubMedSearch in Google Scholar
  • 6 Bakchoul T, Zöllner H, Greinacher A. Current insights into the laboratory diagnosis of HIT. Int J Lab Hematol 2014; 36 (03) 296-305
    CrossrefPubMedSearch in Google Scholar
  • 7 Lo GK, Juhl D, Warkentin TE, Sigouin CS, Eichler P, Greinacher A. Evaluation of pretest clinical score (4 T's) for the diagnosis of heparin-induced thrombocytopenia in two clinical settings. J Thromb Haemost 2006; 4 (04) 759-765
    CrossrefPubMedSearch in Google Scholar
  • 8 Joseph L, Gomes MP, Al Solaiman F. , et al. External validation of the HIT Expert Probability (HEP) score. Thromb Haemost 2015; 113 (03) 633-640
    Thieme ConnectPubMedSearch in Google Scholar
  • 9 Demma LJ, Winkler AM, Levy JH. A diagnosis of heparin-induced thrombocytopenia with combined clinical and laboratory methods in cardiothoracic surgical intensive care unit patients. Anesth Analg 2011; 113 (04) 697-702
    CrossrefPubMedSearch in Google Scholar
  • 10 McFarland J, Lochowicz A, Aster R, Chappell B, Curtis B. Improving the specificity of the PF4 ELISA in diagnosing heparin-induced thrombocytopenia. Am J Hematol 2012; 87 (08) 776-781
    CrossrefPubMedSearch in Google Scholar
  • 11 Mullier F, Minet V, Bailly N. , et al. Platelet microparticle generation assay: a valuable test for immune heparin-induced thrombocytopenia diagnosis. Thromb Res 2014; 133 (06) 1068-1073
    CrossrefPubMedSearch in Google Scholar
  • 12 Marler J, Unzaga J, Stelts S, Oliphant CS. Consequences of treating false positive heparin-induced thrombocytopenia. J Thromb Thrombolysis 2015; 40 (04) 512-514
    CrossrefPubMedSearch in Google Scholar
  • 13 Ortel TL. Heparin-induced thrombocytopenia: when a low platelet count is a mandate for anticoagulation. Hematology (Am Soc Hematol Educ Program) 2009; 1: 225-232
    PubMedSearch in Google Scholar
  • 14 Cosmi B. Current management of heparin-induced thrombocytopenia. Expert Rev Hematol 2015; 8 (06) 837-849
    CrossrefPubMedSearch in Google Scholar
  • 15 Baldwin ZK, Spitzer AL, Ng VL, Harken AH. Contemporary standards for the diagnosis and treatment of heparin-induced thrombocytopenia (HIT). Surgery 2008; 143 (03) 305-312
    CrossrefPubMedSearch in Google Scholar