Pharmacotherapy of heparin-induced thrombocytopenia

William E. Dager, Richard H White

Research output: Contribution to journalArticle

31 Citations (Scopus)

Abstract

Heparin-induced thrombocytopenia (HIT) is a life-and-limb threatening condition that is associated with the development of antibodies that activate platelets and the coagulation system in the presence of unfractionated heparin or low molecular weight heparin. The binding of antibody to heparin-PF-4 complexes can activate platelets, leading to an acute, often catastropic, thrombotic diathesis. The most common laboratory finding is the development of thrombocytopenia 5 or more days after beginning heparin treatment, which occur in up to 1 - 5% of patients exposed to heparin, depending on type of heparin and indication for anticoagulation. The onset of thrombocytopenia can be immediate or delayed for several weeks after the exposure to heparin. Approximately 50 - 60% of patients who develop HIT manifest acute venous or arterial thrombosis and a significant percentage of these patients die or develop vascular gangrene of a limb that requires amputation. Given the severe sequelae associated with HIT, recognition and immediate medical management is essential. Treatment of a patient with HIT is complex, as there are several different anticoagulants now available which have been shown to be useful. Optimal management depends on each patient's individual clinical manifestations, as well as the need for ongoing anticoagulation therapy. No single agent or treatment approach can be considered to be 'standard practice' as very few clinical trials have been completed, compare different treatment options. The use of warfarin alone in a patient with HIT, must be avoided in order to avoid the possibility of further activating coagulation, which may hasten the development of venous limb gangrene. There are several different tests available that detect HIT antibodies and each has different sensitivity and specificity for HIT. In this review we discuss the epidemiology and natural history of HIT, risk factors associated with the development of HIT and the clinical and laboratory tests that aid in the diagnosis and treatment. Special emphasis is given to addressing the management of HIT in special populations, particularly patients with renal or liver disease, acute coronary syndromes, pregnancy, paediatrics and patients who require cardiopulmonary bypass surgery.

Original languageEnglish (US)
Pages (from-to)919-940
Number of pages22
JournalExpert Opinion on Pharmacotherapy
Volume4
Issue number6
DOIs
StatePublished - Jun 1 2003

Fingerprint

Thrombocytopenia
Heparin
Drug Therapy
Gangrene
Extremities
Antibodies
Therapeutics
Blood Platelets
Low Molecular Weight Heparin
Disease Susceptibility
Warfarin
Acute Coronary Syndrome
Natural History
Cardiopulmonary Bypass
Amputation
Anticoagulants
Blood Vessels
Liver Diseases
Epidemiology
Thrombosis

Keywords

  • Argatroban
  • Bivalirudin
  • Danaparoid
  • Direct thrombin inhibitors
  • Fondaparinux
  • Heparin-induced thrombocytopenia
  • Lepirudin
  • Melagatran

ASJC Scopus subject areas

  • Pharmacology (medical)
  • Pharmacology, Toxicology and Pharmaceutics(all)

Cite this

Pharmacotherapy of heparin-induced thrombocytopenia. / Dager, William E.; White, Richard H.

In: Expert Opinion on Pharmacotherapy, Vol. 4, No. 6, 01.06.2003, p. 919-940.

Research output: Contribution to journalArticle

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