Heparin-induced thrombocytopenia - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

Heparin-induced thrombocytopenia (HIT) is a severe drug reaction to heparin that can lead to life- and limb-threatening venous and/or arterial thromboembolism.
Diagnosis requires the combination of a compatible clinical picture and laboratory confirmation of the presence of heparin-dependent platelet-activating HIT antibodies.
The 4Ts score is commonly used to determine the clinical probability of HIT.
Neither discontinuation of heparin alone nor initiation of a vitamin K antagonist alone (e.g., warfarin) is sufficient to stop the development of thrombosis in a patient with acute HIT.
If a patient has suspected HIT and at least an intermediate-probability 4Ts score, all sources of heparin (including low molecular weight heparin) must be discontinued and a nonheparin anticoagulant should be initiated.

Venous limb gangrene of left foot in HIT (dorsal aspect)

Rozati H, Shah SP, Peng YY. Lower limb gangrene postcardiac surgery. BMJ Case Reports. 2013; doi:10.1136/bcr-2012-008362

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History & Exam
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Definition

Epidemiology

Etiology

Pathophysiology

Images

Venous limb gangrene of left foot in HIT: (A) dorsal aspect; (B) medial aspect; and (C) plantar aspect
Combination of clinical picture and laboratory evidence of HIT antibodies
Diagnostic algorithm for heparin-induced thrombocytopenia
Venous limb gangrene of left foot in HIT (dorsal aspect)

Citations

Key Articles

Warkentin T, Kelton J. Temporal aspects of heparin-induced thrombocytopenia. N Engl J Med. 2001;344:1286-1292.[Abstract][Full Text]
Cuker A, Arepally GM, Chong BH, et al. American Society of Hematology 2018 guidelines for management of venous thromboembolism: heparin-induced thrombocytopenia. Blood Adv. 2018 Nov 27;2(22):3360-92.[Abstract][Full Text]
Linkins LA, Dans AL, Moores LK, et al. Treatment and prevention of heparin-induced thrombocytopenia: antithrombotic therapy and prevention of thrombosis (9th ed). American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2012 Feb;141(2 Suppl):e495S-e530S.[Abstract][Full Text]
Watson H, Davidson S, Keeling D, et al. Guidelines on the diagnosis and management of heparin-induced thrombocytopenia: second edition. Br J Haematol. 2012 Dec;159(5):528-40.[Abstract][Full Text]

Referenced Articles

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35. Greinacher A, Alban S, Omer-Adam MA, et al. Heparin-induced thrombocytopenia: a stoichiometry-based model to explain the differing immunogenicities of unfractionated heparin, low-molecular-weight heparin, and fondaparinux in different clinical settings. Thromb Res. 2008;122(2):211-20.[Abstract]
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45. Linkins LA, Bates SM, Lee AY, et al. Combination of 4Ts score and PF4/H-PaGIA for diagnosis and management of heparin-induced thrombocytopenia: prospective cohort study. Blood. 2015 Jul 30;126(5):597-603.[Abstract][Full Text]
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