The management of patients with heparin-induced thrombocytopenia who require anticoagulant therapy.
For patients with heparin-induced thrombocytopenia (HIT), reexposure to heparin is generally not recommended. However, these patients are likely to require anticoagulation therapy at some point in the future. During acute HIT, when thrombocytopenia and anti-heparin-platelet factor 4 antibodies (or HIT antibodies) are present, therapy with heparin must be avoided. In patients with subacute HIT, when platelets have recovered but HIT antibodies are still present, therapy with heparin should be avoided. In patients with a remote history of HIT, when HIT antibodies have cleared, heparin reexposure may be safe, although recurrent HIT has been described in some patients. For all of these patients, the use of alternate anticoagulant agents, including direct thrombin inhibitors and anti-Xa agents, is preferable. There is an increasing amount of data supporting the use of these alternative agents in a wide variety of clinical circumstances, including thromboprophylaxis and treatment of acute thrombosis. Except for a few clinical situations, it is generally possible to avoid heparin reexposure in patients with a history of HIT.
Hassell
Kathryn
K
University of Colorado Health Sciences Center, 4200 East Ninth Ave, C-222, Denver, CO 80262, USA. kathryn.hassell@uchsc.edu
D000789:Angina, Unstable / Q000188:drug therapy; D000906:Antibodies / Q000276:immunology; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D002809:Chondroitin Sulfates / Q000627:therapeutic use; D003871:Dermatan Sulfate / Q000627:therapeutic use; D004338:Drug Combinations; D005260:Female; D000077425:Fondaparinux; D006493:Heparin / Q000009:adverse effects* / Q000276:immunology / Q000627:therapeutic use; D006497:Heparan Sulfate / Q000627:therapeutic use; D006629:Hirudins / Q000031:analogs & derivatives*; D006801:Humans; D008297:Male; D009102:Multiple Organ Failure / Q000188:drug therapy; D010978:Platelet Factor 4 / Q000276:immunology; D011134:Polysaccharides / Q000627:therapeutic use; D011247:Pregnancy; D011300:Preoperative Care; D011994:Recombinant Proteins / Q000627:therapeutic use; D013917:Thrombin / Q000037:antagonists & inhibitors; D013921:Thrombocytopenia / Q000139:chemically induced* / Q000150:complications / Q000276:immunology; D020246:Venous Thrombosis / Q000188:drug therapy
D000906:Antibodies; D000925:Anticoagulants; D002809:Chondroitin Sulfates; D003871:Dermatan Sulfate; D004338:Drug Combinations; D000077425:Fondaparinux; D006493:Heparin; D006497:Heparan Sulfate; D006629:Hirudins; D010978:Platelet Factor 4; D011134:Polysaccharides; D011994:Recombinant Proteins; D013917:Thrombin; C035838:danaparoid; C083544:lepirudin