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Semin Thromb Hemost 2008; 34(1): 086-096
DOI: 10.1055/s-2008-1066027
© Thieme Medical Publishers

The Laboratory Diagnosis and Clinical Management of Patients with Heparin-Induced Thrombocytopenia: An Update

Margaret Prechel1 , Jeanine M. Walenga2
  • 1Assistant Professor, Department of Pathology, Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois
  • 2Professor, Departments of Thoracic & Cardiovascular Surgery and Pathology, Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois
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Publication History

Publication Date:
07 April 2008 (online)

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ABSTRACT

Heparin-induced thrombocytopenia (HIT) is a serious adverse effect of heparin exposure that can progress to severe thrombosis, amputation, or death. HIT is an immune response in which antibodies cause platelet activation, platelet aggregation, the generation of procoagulant platelet microparticles, and activation of leukocytes and endothelial cells. Early diagnosis based on a comprehensive interpretation of clinical and laboratory information is important to improve clinical outcomes. However, limitations of the laboratory assays and atypical clinical presentations can make the diagnosis difficult. Clinical management of patients with HIT is with a non-heparin anticoagulant such as a direct thrombin inhibitor or danaparoid followed by a vitamin K antagonist for long-term treatment. The new anti-factor Xa drugs (fondaparinux, rivaroxaban, apixaban) and other non-heparin antithrombotic agents can potentially be used for the treatment of HIT if clinically validated. Important drug-specific limitations and dosing and monitoring guidelines must be respected for patient safety. Issues still exist regarding the optimal clinical management of HIT.

KEYWORDS

Heparin - thrombocytopenia - antibody - assays - thrombin inhibitor

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Dr. Jeanine M Walenga

Cardiovascular Institute, Building 110

Room 5226, Loyola University Medical Center, Maywood, IL 60153

Email: jwaleng@lumc.edu