American Society of Hematology 2018 guidelines for management of venous thromboembolism: heparin-induced thrombocytopenia
Research article published in Blood advances (2018)
Abstract
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.
Resumen
Heparin-induced thrombocytopenia (HIT) is an adverse drug reaction mediated by platelet-activating antibodies that target complexes of platelet factor 4 and heparin.
Por qué esto importa para la hirudoterapia
Estas guías de práctica clínica de ASH presentan 33 recomendaciones basadas en la evidencia, desarrolladas mediante la metodología GRADE con revisiones sistemáticas de la evidencia, para el diagnóstico y el manejo de la trombocitopenia inducida por heparina (TIH). Entre sus recomendaciones condicionales, las guías abordan la selección entre anticoagulantes no heparínicos para el tratamiento agudo de la TIH, incluida la bivalirudina, un inhibidor directo de la trombina y análogo sintético de la hirudina, el anticoagulante distintivo de la saliva de la sanguijuela medicinal. Para la comunidad de ASH/hirudoterapia, esto resulta genuinamente relevante porque ilustra un escenario clínico importante en el que un descendiente farmacológico del secretoma de la sanguijuela se sitúa explícitamente dentro de la práctica hematológica convencional. La advertencia importante es que la guía aborda el manejo de la TIH de forma amplia y no evalúa la hirudoterapia ni la hirudina nativa derivada de la sanguijuela; la inclusión de la bivalirudina refleja su papel consolidado como fármaco autorizado, y no un aval a la terapia con sanguijuelas en sí misma.
Citación
American Society of Hematology 2018 guidelines for management of venous thromboembolism: heparin-induced thrombocytopenia
Cuker A et al. · Blood advances, 2018
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Añadido a la biblioteca ASH: May 27, 2026 · Última actualización del sitio: 18 de junio de 2026