Heparin-induced thrombocytopenia: natural history, diagnosis, and management

Heparin-induced thrombocytopenia (HIT) is an under-recognized, limb- and life-threatening complication of pharmacologic heparin administration. Antibody formation against heparin complexed to platelet factor 4 (PF4) is central to the pathogenesis of HIT. Heparin:PF4 antibodies promote platelet activation and aggregation as well as excess thrombin generation which may lead to clinical thrombosis. HIT should be suspected in patients who develop thrombocytopenia with or without associated arterial or venous thrombosis while on heparin. HIT is a clinical diagnosis. Specialized HIT assays should be interpreted with care. The cornerstone of HIT management is the discontinuation of all forms of heparin exposure and the institution of anticoagulation with an alternative agent. The direct thrombin inhibitors lepirudin and argatroban are currently available and approved for use in patients with HIT.

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

This review describes HIT as an under-recognized limb- and life-threatening complication of heparin due to heparin-PF4 antibodies that activate platelets and generate thrombin, recommending direct thrombin inhibitors lepirudin and argatroban for HIT management.

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