Heparin-induced thrombocytopenia. Pathogenesis, frequency, avoidance and management.
Review published in Drug safety (1997)
Abstract
Heparin-induced thrombocytopenia (HIT) is an immunoglobulin-mediated adverse drug reaction associated with a high risk of thrombotic complications. The pathogenic antibody, usually immunoglobulin (Ig) G (HIT-IgG), recognises a multimolecular complex of heparin and platelet factor 4, resulting in platelet activation via platelet Fc receptors. In addition to in vivo platelet activation, it is now recognised that there is a concomitant activation of coagulation, as shown by marked elevations in thrombin-antithrombin complex levels. It is possible that this increased thrombin generation predisposes HIT patients to a newly recognised complication: warfarin-induced venous limb gangrene. This syndrome is characterised clinically by necrosis complicating deep venous thrombosis in the absence of large-vessel arterial occlusion, and appears to result from acquired protein C deficiency during warfarin therapy for deep vein thrombosis and HIT. The recommended treatment for HIT is an agent that reduces thrombin generation, either indirectly via factor Xa inhibition [e.g. danaparoid sodium (a mixture of anticoagulant glycosaminoglycans)] or directly using a specific thrombin inhibitor (e.g. recombinant hirudin; argatroban). HIT is potentially preventable: there is a lower frequency of HIT, associated thrombosis and HIT-IgG seroconversion in patients treated with low-molecular-weight heparins, compared with unfractionated heparin.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Resumen
Heparin-induced thrombocytopenia (HIT) is an immunoglobulin-mediated adverse drug reaction associated with a high risk of thrombotic complications. The pathogenic antibody, usually immunoglobulin (Ig) G (HIT-IgG), recognises a multimolecular complex of heparin and platelet factor 4, resulting in...
Por qué esto importa para la hirudoterapia
Esta revisión abarca la patogénesis, la frecuencia, la prevención y el manejo de la trombocitopenia inducida por heparina (HIT), describiéndola como una reacción adversa a medicamentos mediada por IgG con activación plaquetaria y aumento de la generación de trombina, y analiza la gangrena venosa de las extremidades inducida por warfarina como una posible complicación. Para el tratamiento, el resumen enumera agentes que reducen la generación de trombina, incluyendo la hirudina recombinante como un ejemplo de inhibidor directo de la trombina, junto con argatrobán y la opción indirecta danaparoide sódico. Esta mención de la hirudina recombinante es el único punto de contacto con el ámbito de ASH. El resumen no indica que la hirudina sea derivada de sanguijuelas, no aborda la hirudoterapia ni la terapia con sanguijuelas vivas, ni señala la hirudina recombinante como el tratamiento recomendado.
Citación
Heparin-induced thrombocytopenia. Pathogenesis, frequency, avoidance and management.
Warkentin · Drug safety, 1997
Contexto clínico relacionado
Explore cómo esta investigación se conecta con la práctica clínica
Añadido a la biblioteca ASH: May 28, 2026 · Última actualización del sitio: 18 de junio de 2026