heparin-induced thrombocytopenia; heparin-associated antibody syndrome (HIT)

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Etiology

Epidemiology

Pathology

Clinical manifestations

Laboratory

* gold standard[1]

Complications

  • thromboembolic event 5-10 days after starting heparin
    • may occur much earlier (< 10 hours) in patients previously exposed (within 100 days) to unfractionated heparin (re-activation)

Management

Notes

More general terms

Additional terms

References

  1. 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 Medical Knowledge Self Assessment Program (MKSAP) 11, 14, 15, 16, 17, 18, 19. American College of Physicians, Philadelphia 1998, 2006, 2009, 2012, 2015, 2018, 2022.
    Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022
  2. 2.0 2.1 2.2 Journal Watch 21(10):77, 2001 Wartentin TE et al Temporal aspects of heparin-induced thrombocytopenia. N Engl J Med 344:1286, 2001 PMID: https://www.ncbi.nlm.nih.gov/pubmed/11320387
  3. Journal Watch 22(7):57, 2002 Rice L et al Delayed-onset heparin-induced thrombocytopenia. Ann Intern Med 136:210, 2002 PMID: https://www.ncbi.nlm.nih.gov/pubmed/11827497
  4. 4.0 4.1 ARUP Consult: Heparin-Induced Thrombocytopenia - HIT The Physician's Guide to Laboratory Test Selection & Interpretation https://www.arupconsult.com/content/heparin-induced-thrombocytopenia
  5. Cuker A et al. Predictive value of the 4Ts scoring system for heparin- induced thrombocytopenia: A systematic review and meta- analysis. Blood 2012 Nov 15; 120:4160. PMID: https://www.ncbi.nlm.nih.gov/pubmed/22990018
  6. 6.0 6.1 Hong MS, Amanullah AM. Heparin-induced thrombocytopenia: a practical review. Rev Cardiovasc Med. 2010 Winter;11(1):13-25. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20495512
  7. 7.0 7.1 Warkentin TE and Sheppard JI. Serological investigation of patients with a previous history of heparin-induced thrombocytopenia who are re-exposed to heparin. Blood 2014 Feb 10; <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24516044 <Internet> http://bloodjournal.hematologylibrary.org/content/early/2014/02/10/blood-2013-10-533083
  8. 8.0 8.1 8.2 Warkentin TE et al. Spontaneous heparin-induced thrombocytopenia syndrome: 2 new cases and a proposal for defining this disorder. Blood 2014 Jun 5; 123:3651 PMID: https://www.ncbi.nlm.nih.gov/pubmed/24677540
  9. 9.0 9.1 Kang M et al. Fondaparinux for the treatment of suspected heparin-induced thrombocytopenia: A propensity score-matched study. Blood 2014 Dec 16 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25515959 <Internet> http://www.bloodjournal.org/content/early/2014/12/15/blood-2014-09-599498?sso-checked=true
  10. Linkins L-A et al. Combination of 4Ts score and PF4/H-PaGIA for diagnosis and management of heparin-induced thrombocytopenia: Prospective cohort study. Blood 2015 Apr 29; <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25926600 <Internet> http://www.bloodjournal.org/content/early/2015/04/29/blood-2014-12-618165
  11. 11.0 11.1 11.2 Greinacher A Heparin-Induced Thrombocytopenia. N Engl J Med 2015; 373:252-261. July 16, 2015 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26176382 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMcp1411910
  12. 12.0 12.1 Rothaus C Heparin-Induced Thrombocytopenia. http://blogs.nejm.org/now/index.php/heparin-induced-thrombocytopenia/2015/07/17/
  13. Lee GM, Arepally GM. Diagnosis and management of heparin-induced thrombocytopenia. Hematol Oncol Clin North Am. 2013 Jun;27(3):541-63. PMID: https://www.ncbi.nlm.nih.gov/pubmed/23714311
  14. Lee GM, Arepally GM. Heparin-induced thrombocytopenia. Hematology Am Soc Hematol Educ Program. 2013;2013:668-74 PMID: https://www.ncbi.nlm.nih.gov/pubmed/24319250
  15. 15.0 15.1 McGowan KE et al. Reducing the hospital burden of heparin-induced thrombocytopenia: Impact of an avoid-heparin program. Blood 2016 Apr 21; 127:1954 PMID: https://www.ncbi.nlm.nih.gov/pubmed/26817956
  16. 16.0 16.1 Aljabri A et al. Cost-effectiveness of anticoagulants for the management of suspected heparin-induced thrombocytopenia in the US. Blood 2016 Oct 28; PMID: https://www.ncbi.nlm.nih.gov/pubmed/27793877
  17. 17.0 17.1 Warkentin TE, Pai M, Linkins LA. Direct oral anticoagulants for treatment of HIT: Update of Hamilton experience and literature review. Blood 2017 Jun 23; blood-2017-04-778993 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28646118 <Internet> http://www.bloodjournal.org/content/early/2017/06/23/blood-2017-04-778993
  18. NEJM Knowledge+ Question of the Week. March 31, 2020 https://knowledgeplus.nejm.org/question-of-week/377/
  19. Larsen EL et al. Accuracy of diagnosing heparin-induced thrombocytopenia. JAMA Netw Open 2024 Mar; 7:e243786. PMID: https://www.ncbi.nlm.nih.gov/pubmed/38530310 PMCID: PMC10966416 Free PMC article https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2816742