Heparin-induced thrombocytopenia. A contemporary clinical approach to diagnosis and management.
Thrombocytopenia following heparin administration can be associated with an immune reaction, now referred to as heparin-induced thrombocytopenia (HIT). HIT is essentially a prothrombotic disorder mediated by an IgG antiplatelet factor 4/heparin antibody, which induces platelet, endothelial cell, monocyte, and other cellular activation, leading to thrombin generation and thrombotic complications. Indeed, HIT can also be regarded as a serious adverse drug effect. Importantly, HIT can be a life-threatening and limb-threatening condition frequently associated with characteristically severe and extensive thromboembolism (both venous and arterial) rather than with bleeding. This article provides an overview of HIT, with an emphasis on the clinical diagnosis and management.
Shantsila
Eduard
E
Haemostasis Thrombosis and Vascular Biology Unit, University Department of Medicine, City Hospital, Birmingham, UK. Electronic address: shantsila@yandex.ru.
Lip
Gregory Y H
GYH
Haemostasis Thrombosis and Vascular Biology Unit, University Department of Medicine, City Hospital, Birmingham, UK.
Chong
Beng H
BH
Department of Haematology, St. George Hospital, Kogarah, NSW, Australia; SGCS, University of New South Wales, Kensington, NSW, Australia.
D000925:Anticoagulants / Q000009:adverse effects* / Q000627:therapeutic use; D001120:Arginine / Q000031:analogs & derivatives; D002809:Chondroitin Sulfates / Q000008:administration & dosage / Q000009:adverse effects; D003871:Dermatan Sulfate / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D006493:Heparin / Q000009:adverse effects* / Q000627:therapeutic use; D006497:Heparan Sulfate / Q000008:administration & dosage / Q000009:adverse effects; D006629:Hirudins / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D008297:Male; D008991:Monitoring, Physiologic; D010446:Peptide Fragments / Q000008:administration & dosage / Q000009:adverse effects; D010875:Pipecolic Acids; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D010976:Platelet Count; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000009:adverse effects; D012307:Risk Factors; D017751:Safety Management; D012720:Severity of Illness Index; D013449:Sulfonamides; D015996:Survival Rate; D013921:Thrombocytopenia / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy; D013927:Thrombosis / Q000188:drug therapy / Q000517:prevention & control; D013997:Time Factors
D000925:Anticoagulants; D001120:Arginine; D002809:Chondroitin Sulfates; D003871:Dermatan Sulfate; D006493:Heparin; D006497:Heparan Sulfate; D006629:Hirudins; D010446:Peptide Fragments; D010875:Pipecolic Acids; D010975:Platelet Aggregation Inhibitors; D011994:Recombinant Proteins; D013449:Sulfonamides; C035838:danaparoid; C031942:argatroban; C074619:bivalirudin; C083544:lepirudin