Developing an algorithm for treating heparin-induced thrombocytopenia.
Heparin-induced thrombocytopenia (HIT) is a serious and common complication of heparin therapy that can lead to significant losses of life and limb. It is often under-recognized and, therefore, goes untreated until thrombosis develops. This article is meant to provide specific recommendations for treating patients with immune-mediated HIT, whether or not it is associated with thrombosis. These recommendations are based on our clinical experience treating patients with HIT and our evaluation of the published data on the efficacy and safety of lepirudin and argatroban, the 2 drugs approved by the Food and Drug Administration for treating HIT. Based on these criteria, we consider lepirudin the treatment of choice in all patients with HIT except those with severe or deteriorating renal function.
McIntosh
Bruce A
BA
Department of Pharmacy Practice and Science, University of Kentucky, Lexington, KY 40536, USA. bamcin00@uky.edu
D000465:Algorithms; D000925:Anticoagulants / Q000009:adverse effects*; D000936:Antigen-Antibody Complex / Q000276:immunology; D001120:Arginine / Q000031:analogs & derivatives; D002986:Clinical Trials as Topic; D003937:Diagnosis, Differential; D019468:Disease Management; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000209:etiology; D006493:Heparin / Q000009:adverse effects*; D006495:Heparin, Low-Molecular-Weight / Q000009:adverse effects; D006629:Hirudins / Q000008:administration & dosage; D006801:Humans; D007074:Immunoglobulin G / Q000276:immunology; D010875:Pipecolic Acids / Q000008:administration & dosage / Q000627:therapeutic use; D015539:Platelet Activation; D010976:Platelet Count; D010978:Platelet Factor 4 / Q000276:immunology; D011379:Prognosis; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy*; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000627:therapeutic use; D013449:Sulfonamides; D013921:Thrombocytopenia / Q000139:chemically induced / Q000188:drug therapy; D019851:Thrombophilia / Q000139:chemically induced; D013997:Time Factors
D000925:Anticoagulants; D000936:Antigen-Antibody Complex; D006495:Heparin, Low-Molecular-Weight; D006629:Hirudins; D007074:Immunoglobulin G; D010875:Pipecolic Acids; D011994:Recombinant Proteins; D013449:Sulfonamides; D010978:Platelet Factor 4; D006493:Heparin; D001120:Arginine; C031942:argatroban; C083544:lepirudin