Heparin-induced Thrombocytopenia: Towards Consensus

TLDR

Heparin‑induced thrombocytopenia is a common drug‑induced immunohematologic disorder that can cause life‑ and limb‑threatening thrombotic complications and for which optimal treatment remains uncertain. This review summarizes emerging consensus on HIT frequency, pathogenesis, diagnostic testing, and the rationale for thrombin‑inhibiting therapies. The authors discuss how HIT activates coagulation pathways, supporting treatment strategies that target thrombin with agents such as danaparoid sodium and hirudin analogues.

Abstract

Summary Heparin-induced thrombocytopenia (HIT) is a drug-induced, immunoglobulin-mediated thrombocytopenic disorder that is important for at least three reasons. First, it is a relatively common drug-induced immunohematologic adverse reaction. Second, it is frequently complicated by life- and limb-threatening thrombotic complications. And third, there remains uncertainty about the optimal treatment approach for these patients. Recently, there has emerged increasing consensus on such important issues as the frequency, pathogenesis, and diagnostic testing, which we will summarize here. Further, a greater appreciation of the activation of the coagulation pathways in this syndrome indicate a rationale to treatment approaches that emphasize thrombin inhibition (eg. danaparoid sodium; hirudin and its analogues).