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2012, Number 1

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Med Sur 2012; 19 (1)

Heparin-induced thrombocytopenia

Carrillo-Esper R, Zárate-Vega V, Medrano-del-Ángel T, Andrade-Montes de Oca G

Language: Spanish
References: 36
Page: 15-22
PDF size: 249.19 Kb.


ABSTRACT

Heparin induce thrombocytopenia (HIT) is an immune-mediated transient prothrombotic state with very severe implications determined by thromboembolic phenomena in both the venous and arterial circulation. The propensity for thrombosis distinguishes HIT from other common drug-induced thrombocytopenias. Diagnosing HIT in hospitalized patients is often challenging because of the frequency of heparin use, occurrence of thrombocytopenia from other causes, and development of asymptomatic PF4/heparin antibodies in patients treated with heparin. The heparin-platelet factor 4-antibody assay, polyanion-platelet factor 4-antibody assay and heparin- induced platelet activation test are used for laboratory diagnosis of the immune form of heparin-induced thrombocytopenia. For patients with strongly suspected or confirmed HIT, heparin should be stopped and full-dose anticoagulation with an alternative, such as lepirudin or danaparoid, commenced (in the absence of a significant contraindication). Warfarin should not be used until the platelet count has recovered. When introduced in combination with warfarin, an alternative anticoagulant must be continued until the International Normalized Ratio (INR) is therapeutic for two consecutive days. Platelets should not be given for prophylaxis or treatment. HIT is a potentially fatal but treatable and largely preventable disease. An increased awareness of the signs and symptoms of the disorder is necessary to prevent its potentially devastating complications.


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