title: Management and Outcome of Heparin-Induced Thrombocytopenia in Pregnancy: A Systematic Review.
abstract: OBJECTIVE
  Safety and efficacy of therapeutic agents used for heparin-induced thrombocytopenia are not established in pregnancy.
  
  
  METHODS
  MEDLINE database was searched in November 2014 to identify all patients who received therapy for HIT during pregnancy.
  
  
  RESULTS
  A total of 12 patients with the median age of 28 years (range 21-39) were diagnosed with HIT at the median gestational age of 20 weeks (range 5-34). Clinical probability (4T) score for HIT was high (50%) or intermediate (50%) and associated with thrombosis in 50%. Patients were initially managed with lepirudin (33%), argatroban (25%), danaparoid (25%) or fondaparinux (17%) and ultimately bridged to vitamin K antagonist or maintained on lepirudin. All patients had resolution of HIT. Complications included therapeutic abortion prior to valve replacement for valve thrombosis (8%), preterm delivery (18%) and preeclampsia (8%). Except for one instance of hypoplastic lung related to preterm delivery, none of the other newborns had any complications during delivery.
  
  
  CONCLUSIONS
  Confirmed cases of HIT in pregnant patients appear to be rare. Within the limits of retrospective analysis, the use of argatroban, danaparoid, fondaparinux and lepirudin may be effective in preventing the thrombotic complications of HIT in pregnancy. The effect of HIT or its therapy on obstetrical complications cannot be determined based on this study since many of the obstetrical complications are common in otherwise healthy pregnancies. Although this study did not identify any fetal teratogenicity except hypoplastic lung related to preterm delivery, small number of cases treated with various therapies precludes any definite conclusion.
authors.forename: Ranjit K
authors.initials: RK
authors.lastname: Chaudhary
authors.forename: Chhabindra
authors.initials: C
authors.lastname: Nepal
authors.forename: Nabin
authors.initials: N
authors.lastname: Khanal
authors.forename: Ranjan
authors.initials: R
authors.lastname: Pathak
authors.forename: Smith
authors.initials: S
authors.lastname: Giri
authors.affiliation: University of Nebraska Medical Center, Department of Internal Medicine, Division of Hematology- Oncology, 987680 Nebraska Medical Center, Omaha, NE 68198-7680, USA. vijaya.bhatt@unmc.edu.
authors.forename: Vijaya R
authors.initials: VR
authors.lastname: Bhatt
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use; D005260:Female; D006493:Heparin / Q000009:adverse effects*; D006801:Humans; D011247:Pregnancy; D012189:Retrospective Studies; D013921:Thrombocytopenia / Q000139:chemically induced* / Q000188:drug therapy*
chemical_list: D000925:Anticoagulants; D006493:Heparin