ISSUE 1391
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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
... more1. TE Warkentin. How I diagnose and manage HIT. Hematology Am Soc Hematol Educ Program 2011; 2011:143.
2. A Cuker and DB Cines. How I treat heparin-induced thrombocytopenia. Blood 2012; 119:2209.
6. Argatroban for treatment of heparin-induced thrombocytopenia. Med Lett Drugs Ther 2001; 43:11.
11. TE Warkentin. HIT paradigms and paradoxes. J Thromb Haemost 2011; 9(suppl1):105.
12. Antithrombotic drugs. Treat Guidel Med Lett 2011; 9: 61.
13. TE Warkentin. Fondaparinux: does it cause HIT? Can it treat HIT? Expert Rev Hematol 2010; 3:567.
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