Patient Education
The presence of PF4 antibodies is transient (50 to 80 days); however, concern persists regarding recurrent antibody development with subsequent heparin use. Thus, an alternative anticoagulant should be used whenever possible. Patients who have been diagnosed with HIT should be advised to inform future health care professionals regarding their need for alternative anticoagulation whenever possible.
Patients should also be made aware that when the risk for DTI-associated bleeding is too great (as in the case of cardiac surgery), heparin remains the anticoagulant of choice.9,15
Conclusion
Heparin-induced thrombocytopenia is a transient development of antibodies to heparin. While the condition carries a high risk for morbidity and mortality, early detection and prompt treatment can greatly reduce the associated risk to life and limb.
References
1. Kanaan AO, Al-Homsi AS. Heparin-induced thrombocytopenia: pathophysiology, diagnosis, and review of pharmacotherapy. J Pharm Pract. 2009;22:149-157.
2. LaMuraglia GM, Houbballah R, Laposata M. The identification and management of heparin-induced thrombocytopenia in the vascular patient. J Vasc Surg. 2012;55:562-570.
3. Rauova L, Zhai L, Kowalska MA, et al. Role of platelet surface PF4 antigenic complexes in heparin-induced thrombocytopenia pathogenesis: diagnostic and therapeutic implications. Blood. 2006;107:2346-2353.
4. Suvarna S, Espinasse B, Qi R, et al. Determinants of PF4/heparin immunogenicity. Blood. 2007;110:4253-4260.
5. Linkins LA, Dans AL, Moores LK, et al. Treatment and prevention of heparin-induced thrombocytopenia: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(2 suppl):e495S-e530S.
6. Demma LJ, Winkler AM, Levy JH. A diagnosis of heparin-induced thrombocytopenia with combined clinical and laboratory methods in cardiothoracic surgical intensive care unit patients. Anesth Analg. 2011;113:697-702.
7. Demma LJ, Levy JH. Diagnosing heparin-induced thrombocytopenia in cardiac surgical patients: not as easy as you think. Anesth Analg. 2011;112:747-749.
8. Alaraj A, Wallace A, Tesoro E, et al. Heparin-induced thrombocytopenia: diagnosis and management. J Neurointervent Surg. 2010;2:371-378.
9. Arepally GM, Ortel TL. Heparin-induced thrombocytopenia. N Engl J Med. 2006;355:809-817.
10. Sud S, Mittmann N, Cook DJ, et al. Screening and prevention of venous thromboembolism in critically ill patients: a decision analysis and economic evaluation. Am J Resp Crit Care Med. 2011;184:1289-1298.
11. Shaikh N. Heparin-induced thrombocytopenia. J Emerg Trauma Shock. 2011;14:97-102.
12. Cuker A. Heparin-induced thrombocytopenia: present and future. J Thromb Thrombolysis. 2011;31:353-366.
13. Locke CSF, Dooley J, Gerber J. Rates of clinically apparent heparin-induced thrombocytopenia for unfractionated heparin vs low molecular weight heparin in non-surgical patients are low and similar. Thromb J. 2005;3:4.
14. Cuker A. Recent advances in heparin-induced thrombocytopenia. Curr Opin Hematol. 2011;18:315-322.
15. Warkentin TE, Greinacher A, Koster A, Lincoff AM. Treatment and prevention of heparin-induced thrombocytopenia: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th ed). Chest. 2008;133(6 suppl):340S-380S.
16. Junqueira DR, Perini E, Penholati RR, Carvalho MG. Unfractionated heparin versus low molecular weight heparin for avoiding heparin-induced thrombocytopenia in postoperative patients. Cochrane Database Syst Rev. 2012;9:CD007557.
17. Berry C, Tcherniantchouk O, Ley EJ, et al. Overdiagnosis of heparin-induced thrombocytopenia in surgical ICU patients. J Am Coll Surg. 2011;213:10-17.
18. Cuker A. Current and emerging therapeutics for heparin-induced thrombocytopenia. Semin Thromb Hemost. 2012;38:31-37.
19. Warkentin TE. New approaches to the diagnosis of heparin-induced thrombocytopenia. Chest. 2005;127(2 suppl):35S-45S.
20. Fennessy-Cooney M. Heparin-induced thrombocytopenia. Nurse Pract. 2011;36:31-37.
21. Bryant A, Low J, Austin S, Joseph JE. Timely diagnosis and management of heparin-induced thrombocytopenia in a frequent request, low incidence single centre using clinical 4T's score and particle gel immunoassay. Br J Haematol. 2008;143:721-726.
22. Lo GK, Juhl D, Warkentin TE, et al. Evaluation of pretest clinical score (4 T's) for the diagnosis of heparin-induced thrombocytopenia in two clinical settings. J Thromb Haemost. 2006;4:759-765.
23. Wirth SM, Macaulay TE, Armistead JA, et al. Evaluation of a clinical scoring scale to direct early appropriate therapy in heparin-induced thrombocytopenia. J Oncol Pharm Pract. 2010;16:161-166.
24. Yoon JH, Jang IK. Heparin-induced thrombocytopenia in cardiovascular patients: pathophysiology, diagnosis, and treatment. Cardiol Rev. 2011;19:143-153.
25. Bartholomew JR. Heparin-induced thrombocytopenia: 2008 update. Curr Treat Options Cardiovasc Med. 2008;10:117-127.
26. Warkentin TE. Platelet count monitoring and laboratory testing for heparin-induced thrombocytopenia. Arch Pathol Lab Med. 2002;126:1415-1423.
27. Badger NO. Fondaparinux (Arixtra®), a safe alternative for the treatment of patients with heparin-induced thrombocytopenia? J Pharm Pract. 2010;23:235-238.
28. Petros S. Lepirudin in the management of patients with heparin-induced thrombocytopenia. Biologics. 2008;2:481-490.
29. Warkentin TE. How I diagnose and manage HIT. Hematology Am Soc Hematol Educ Program. 2011;2011:143-149.
30. Papadopoulos S, Flynn JD, Lewis DA. Fondaparinux as a treatment option for heparin-induced thrombocytopenia. Pharmacotherapy. 2007; 27:921-926.