American Society of Hematology 2018 guidelines for management of venous thromboembolism: heparin-induced thrombocytopenia

BACKGROUND: Heparin-induced thrombocytopenia (HIT) is an adverse drug reaction mediated by platelet-activating antibodies that target complexes of platelet factor 4 and heparin. Patients are at markedly increased risk of thromboembolism. OBJECTIVE: These evidence-based guidelines of the American Society of Hematology (ASH) are intended to support patients, clinicians, and other health care professionals in their decisions about diagnosis and management of HIT. METHODS: ASH formed a multidisciplinary guideline panel balanced to minimize potential bias from conflicts of interest. The McMaster University GRADE Centre supported the guideline development process, including updating or performing systematic evidence reviews. The panel prioritized clinical questions and outcomes according to their importance for clinicians and patients. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess evidence and make recommendations, which were subject to public comment. RESULTS: The panel agreed on 33 recommendations. The recommendations address screening of asymptomatic patients for HIT, diagnosis and initial management of patients with suspected HIT, treatment of acute HIT, and special situations in patients with acute HIT or a history of HIT, including cardiovascular surgery, percutaneous cardiovascular intervention, renal replacement therapy, and venous thromboembolism prophylaxis. CONCLUSIONS: Strong recommendations include use of the 4Ts score rather than a gestalt approach for estimating the pretest probability of HIT and avoidance of HIT laboratory testing and empiric treatment of HIT in patients with a low-probability 4Ts score. Conditional recommendations include the choice among non-heparin anticoagulants (argatroban, bivalirudin, danaparoid, fondaparinux, direct oral anticoagulants) for treatment of acute HIT.

Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.

The 2018 ASH guidelines provide 33 evidence-based recommendations for diagnosing and managing heparin-induced thrombocytopenia, strongly endorsing the 4Ts score and conditionally recommending non-heparin anticoagulants including argatroban, bivalirudin, danaparoid, fondaparinux, or direct oral anticoagulants for acute HIT.

Explore how this research connects to clinical practice

More peer-reviewed studies in Drug Development.

• Hirudotherapy in Medicine and Dentistry — Jha K et al. (2015)
• Leech therapy: a history — Hyson J (2005)
• Hirudins of the Asian medicinal leech, Hirudinaria manillensis: same same, but different — Lukas P et al. (2019)
• Transcriptomic analysis of the salivary gland of medicinal leech Hirudo nipponia — Lu Z et al. (2018)
• Molecular dynamic and pharmacological studies on protein-engineered hirudin variants of Hirudinaria manillensis and Hirudo medicinalis — Sun Y et al. (2022)
• Cell-free synthesis of the hirudin variant 1 of the blood-sucking leech Hirudo medicinalis — Wüstenhagen D et al. (2020)
• Hirudin variants production by genetic engineered microbial factory — Zhang J, Lan N (2018)
• Hirudin in heparin-induced thrombocytopenia — Lubenow N, Greinacher A (2002)
• Hirudin ameliorates diabetic nephropathy by inhibiting Gsdmd-mediated pyroptosis — Han J et al. (2023)
• Hirudin as alternative anticoagulant--a historical review — Markwardt F (2002)

Browse all ASH-analysed research →