title: Have You Been HIT?
abstract: This review is specifically designed to aid the vascular surgeon in the management of heparin-induced thrombocytopenia (HIT). Heparin-induced thrombocytopenia is a rare complication of heparin administration, which poses significant morbidity and mortality. Its onset is usually 5 to 10 days after the heparin administration and should be suspected if platelet counts drop by at least 50%. Confirmation is given by the presence of HIT antibodies on an enzyme-linked immunosorbent assay (ELISA) or in functional platelet activation assays. The major complication is thrombosis and surprisingly bleeding is rare. Heparin must be stopped immediately if there is a clinical suspicion of HIT and alternative anticoagulation must be started. Anticoagulation is required for at least 2 to 3 months to prevent recurrence of thrombosis. Oral anticoagulation with warfarin should not be initiated until the platelet count has been recovered and there should be an overlap of at least 5 days between starting warfarin and stopping the alternative anticoagulant.
authors.affiliation: Department of Vascular Surgery, John Radcliffe Hospital, Oxford, UK. jane.cross@yahoo.co.uk
authors.forename: Jane
authors.initials: J
authors.lastname: Cross
authors.forename: Mary
authors.initials: M
authors.lastname: Weisters
authors.forename: Robina
authors.initials: R
authors.lastname: Aslam
authors.forename: David
authors.initials: D
authors.lastname: Keeling
authors.forename: Ashok
authors.initials: A
authors.lastname: Handa
mesh_terms: D000925:Anticoagulants / Q000009:adverse effects*; D001779:Blood Coagulation Factors / Q000187:drug effects / Q000378:metabolism; D006493:Heparin / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D019990:Perioperative Care / Q000379:methods; D012307:Risk Factors; D013921:Thrombocytopenia / Q000097:blood / Q000139:chemically induced / Q000453:epidemiology; D013927:Thrombosis / Q000209:etiology / Q000517:prevention & control*; D006113:United Kingdom / Q000453:epidemiology; D014656:Vascular Surgical Procedures / Q000009:adverse effects*
chemical_list: D000925:Anticoagulants; D001779:Blood Coagulation Factors; D006493:Heparin