, Volume 16, Issue 3, pp 237-247

Heparin-induced thrombocytopenia and thrombosis

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Although significant strides have been made in the last two decades toward understanding the immunopathogenesis of HITT, challenges remain in understanding key biological and clinical aspects of this disease. It is still unclear how binding of heparin to PF4 elicits an autoimmune response, how PF4/heparin antibodies promote thrombosis, why thrombosis occurs in such a small subset of patients with PF4/heparin antibodies, or whether heparin fragments with anticoagulant activity but lacking the propensity to elicit and immune response can be brought into clinical practice. Lastly, development of additional safe alternative anticoagulants for patients with life- and limb-threatening thrombosis is desperately needed.