How we manage patients with heparin induced thrombocytopenia.
Heparin induced thrombocytopenia (HIT) remains a rare, but significant, condition related to mortality and morbidity. The incidence has decreased with reduced use of unfractionated heparin, with the exception of cardiac surgery. Due to the high risk of thrombosis, a switch to a non-heparin anticoagulant is required, until platelet counts normalize. Within the acute setting, argatroban, fondaparinux and direct acting oral anticoagulants (DOACS) are therapeutic options. In patients with HIT-associated thrombosis or who require long-term anticoagulation, warfarin remains the preference, but DOACs are attractive alternatives.
Department of Haematology, University College London Hospital, Cardiometabolic Programme-NIHR UCLH/UCL BRC, London, UK.
Marie
M
Scully
Thrombosis and Anticoagulant Pharmacist, University College London Hospital, London, UK.
Carolyn
C
Gates
Specialist Registrar, Department of Haematology, UCLH, London, UK.
Lucy
L
Neave
D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use; D001120:Arginine / Q000031:analogs & derivatives; D019468:Disease Management; D000077425:Fondaparinux; D006493:Heparin / Q000009:adverse effects*; D006801:Humans; D010875:Pipecolic Acids / Q000627:therapeutic use; D011134:Polysaccharides / Q000627:therapeutic use; D013449:Sulfonamides; D013921:Thrombocytopenia / Q000139:chemically induced / Q000188:drug therapy*; D014859:Warfarin / Q000627:therapeutic use
D000925:Anticoagulants; D010875:Pipecolic Acids; D011134:Polysaccharides; D013449:Sulfonamides; D014859:Warfarin; D006493:Heparin; D001120:Arginine; C031942:argatroban; D000077425:Fondaparinux
direct acting oral anticoagulants; heparin induced thrombocytopenia; non heparin anticoagulants; thrombosis