title: Heparin-Induced Thrombocytopenia: A Comprehensive Clinical Review.
abstract: Heparin-induced thrombocytopenia is a profoundly dangerous, potentially lethal, immunologically mediated adverse drug reaction to unfractionated heparin or, less commonly, to low-molecular weight heparin. In this comprehensive review, the authors highlight heparin-induced thrombocytopenia's risk factors, clinical presentation, pathophysiology, diagnostic principles, and treatment. The authors place special emphasis on the management of patients requiring procedures using cardiopulmonary bypass or interventions in the catheterization laboratory. Clinical vigilance of this disease process is important to ensure its recognition, diagnosis, and treatment. Misdiagnosis of the syndrome, as well as misunderstanding of the disease process, continues to contribute to its morbidity and mortality.
authors.affiliation: Department of Anesthesiology, Mount Sinai Medical Center, New York, New York. Electronic address: benjamin.salter@mountsinai.org.
authors.forename: Benjamin S
authors.initials: BS
authors.lastname: Salter
authors.affiliation: Department of Anesthesiology, Mount Sinai Medical Center, New York, New York.
authors.forename: Menachem M
authors.initials: MM
authors.lastname: Weiner
authors.affiliation: Department of Anesthesiology, Mount Sinai Medical Center, New York, New York.
authors.forename: Muoi A
authors.initials: MA
authors.lastname: Trinh
authors.affiliation: Department of Anesthesiology, Mount Sinai Medical Center, New York, New York.
authors.forename: Joshua
authors.initials: J
authors.lastname: Heller
authors.affiliation: Department of Anesthesiology, Mount Sinai Medical Center, New York, New York.
authors.forename: Adam S
authors.initials: AS
authors.lastname: Evans
authors.affiliation: Department of Cardiac Surgery, Mount Sinai Medical Center, New York, New York.
authors.forename: David H
authors.initials: DH
authors.lastname: Adams
authors.affiliation: Department of Anesthesiology, Mount Sinai Medical Center, New York, New York.
authors.forename: Gregory W
authors.initials: GW
authors.lastname: Fischer
mesh_terms: D000925:Anticoagulants / Q000009:adverse effects*; D000991:Antithrombins / Q000493:pharmacokinetics / Q000627:therapeutic use; D001120:Arginine / Q000031:analogs & derivatives; D002315:Cardiopulmonary Bypass; D000077425:Fondaparinux; D006493:Heparin / Q000009:adverse effects*; D006629:Hirudins / Q000493:pharmacokinetics; D006801:Humans; D015994:Incidence; D010446:Peptide Fragments / Q000493:pharmacokinetics / Q000627:therapeutic use; D062645:Percutaneous Coronary Intervention; D010875:Pipecolic Acids / Q000493:pharmacokinetics / Q000627:therapeutic use; D010956:Plasmapheresis; D010979:Platelet Function Tests; D017713:Platelet Transfusion; D011134:Polysaccharides / Q000627:therapeutic use; D011994:Recombinant Proteins / Q000493:pharmacokinetics / Q000627:therapeutic use; D012307:Risk Factors; D013449:Sulfonamides; D013921:Thrombocytopenia / Q000139:chemically induced* / Q000175:diagnosis / Q000628:therapy
chemical_list: D000925:Anticoagulants; D000991:Antithrombins; D006629:Hirudins; D010446:Peptide Fragments; D010875:Pipecolic Acids; D011134:Polysaccharides; D011994:Recombinant Proteins; D013449:Sulfonamides; D006493:Heparin; D001120:Arginine; C031942:argatroban; D000077425:Fondaparinux; C074619:bivalirudin
keywords: anticoagulant agents; antithrombin agents; argatroban; bivalirudin; cardiopulmonary bypass; platelets