Heparin-induced thrombocytopenia: a general review.
Unfractionated heparin is widely used for numerous clinical situations. A well-known adverse effect of heparin exposure is thrombocytopenia. Heparin-induced thrombocytopenia is a clinicopathologic syndrome that can be associated with severe complications and significant mortality. The pathophysiology of heparin-induced thrombocytopenia includes an immune-mediated reaction to heparin that activates platelets and results in an acquired hypercoagulability. Diagnosis of heparin-induced thrombocytopenia should incorporate clinical signs and symptoms and laboratory testing for heparin-induced thrombocytopenia antibodies. Therapy should include discontinuation of heparin, initiation of a direct thrombin inhibitor, and eventually therapy with warfarin (only after the platelet count is at least 100 x 10(9)/L).
Joseph M. Swanson is Assistant Professor, Department of Clinical Pharmacy, University of Tennessee Health Science Center, Memphis, TN 38163, USA. jswanson@utmem.edu
Joseph M
JM
Swanson
D000925:Anticoagulants / Q000009:adverse effects*; D001120:Arginine / Q000031:analogs & derivatives; D016903:Drug Monitoring; D065427:Factor Xa Inhibitors; D000077425:Fondaparinux; D006493:Heparin / Q000009:adverse effects*; D006629:Hirudins; D006801:Humans; D009730:Nursing Assessment; D010446:Peptide Fragments / Q000627:therapeutic use; D010875:Pipecolic Acids / Q000627:therapeutic use; D015539:Platelet Activation; D010976:Platelet Count; D011134:Polysaccharides / Q000627:therapeutic use; D011994:Recombinant Proteins / Q000627:therapeutic use; D012307:Risk Factors; D013449:Sulfonamides; D013917:Thrombin / Q000037:antagonists & inhibitors; D013921:Thrombocytopenia / Q000139:chemically induced* / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D013997:Time Factors; D016896:Treatment Outcome; D014859:Warfarin / Q000627:therapeutic use
D000925:Anticoagulants; D065427:Factor Xa Inhibitors; D006629:Hirudins; D010446:Peptide Fragments; D010875:Pipecolic Acids; D011134:Polysaccharides; D011994:Recombinant Proteins; D013449:Sulfonamides; D014859:Warfarin; D006493:Heparin; D001120:Arginine; D013917:Thrombin; C031942:argatroban; D000077425:Fondaparinux; C074619:bivalirudin; C083544:lepirudin