The Medical Letter on Drugs and Therapeutics
Choice of Drugs for Heparin-Induced Thrombocytopenia
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A reader has asked us to review the choice of drugs for heparin-induced thrombocytopenia (HIT), a prothrombotic state with high morbidity and mortality. Three recent publications have made somewhat different recommendations on its treatment.1-3

HIT — Antibody-mediated severe HIT develops in 0.2%-5% of patients receiving heparin for more than 4 days; the incidence is less than 1% with low-molecular-weight heparin. Antibodies against multimolecular complexes of platelet factor 4 (PF4) bound to heparin activate platelets, resulting in thrombocytopenia. The primary treatment is to discontinue heparin and start a non-heparin anticoagulant. Once the thrombocytopenia resolves, most patients are transitioned to an oral vitamin K antagonist such as warfarin.

DIAGNOSIS — HIT is overdiagnosed because the most common diagnostic test is a serum enzyme immunoassay ... more      

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Title: Choice of Drugs for Heparin-Induced Thrombocytopenia
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