Heparin-induced thrombocytopenia
Narrative review published in Seminars in cardiothoracic and vascular anesthesia (2010)
Abstract
Heparin-induced thrombocytopenia (HIT) is an antibody-mediated reaction caused by exposure to heparin that can lead to devastating thrombotic complications. HIT usually occurs 5 to 10 days after exposure to heparin but can happen more rapidly to patients who are reexposed to heparin within 100 days. The hallmark of this disorder is a sudden drop in platelet count of greater than 50%. Once HIT is suspected the heparin must be immediately discontinued and an anticoagulant (direct thrombin inhibitor or heparinoid) started. For patients presenting for cardiac surgery and cardiopulmonary bypass that have a history of HIT and positive antibodies a direct thrombin inhibitor such as lepirudin, argatroban or bivalirudin must be used in lieu of heparin.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Summary
This review covers heparin-induced thrombocytopenia, an antibody-mediated reaction appearing 5-10 days after heparin with a platelet drop over 50%; heparin must be stopped and a direct thrombin inhibitor or heparinoid used, including lepirudin, argatroban or bivalirudin in cardiac surgery.
Why This Matters for Hirudotherapy
This review provides an overview of heparin-induced thrombocytopenia (HIT), emphasizing the immediate cessation of heparin and the use of alternative anticoagulants. It specifically recommends direct thrombin inhibitors such as lepirudin, a recombinant form of leech-derived hirudin, for cardiac surgery patients with a history of HIT. The article is a clinical overview of HIT management and does not address live hirudotherapy or the broader leech secretome.
Citation
Added to ASH library: May 28, 2026 · Site last updated: November 1, 2026