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Heparin-Induced Thrombocytopenia

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Abstract

Heparin-induced thrombocytopenia (HIT) is a common adverse effect of heparin (UFH) or any of the low-molecular-weight heparin (LMWH) preparations. It is a transient, prothrombotic condition that can result in venous and/or arterial thrombosis, amputation, or even death. HIT usually develops within either 5–14 days after administration of anticoagulant, although it may occur more rapidly if there has been a recent exposure, or delayed days to weeks after either UFH or LMWH has been discontinued. Thrombocytopenia is the most common presentation, although in as many as 25 % of patients, thrombosis develops before thrombocytopenia occurs. The diagnosis is based on both the clinical presentation and laboratory testing. Prompt recognition, immediate discontinuation of the offending anticoagulant, and initiation of an alternative anticoagulant such as a direct thrombin inhibitor are essential for preventing and/or treating this potentially devastating complication.

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Abbreviations

ACCP:

American College of Chest Physicians

ACS:

Acute coronary syndrome

ACT:

Activated clotting time

aPTT:

Activated partial thromboplastin time

CABG:

Coronary artery bypass grafting

DIC:

Disseminated intravascular coagulation

DTI:

Direct thrombin inhibitor

DVT:

Deep vein thrombosis

FDA:

Food and Drug Administration

HAT:

Heparin-associated thrombosis

HEP:

Heparin expert probability score

HISN:

Heparin-induced skin necrosis

HIPA:

Heparin-induced platelet aggregation

INR:

International normalized ratio

ITP:

Idiopathic thrombocytopenia purpura

HIT:

Heparin-induced thrombocytopenia

LMWH:

Low-molecular-weight heparin

MI:

Myocardial infarction

OD:

Optical density

PCI:

Percutaneous coronary intervention

PE:

Pulmonary embolism

PF4:

Platelet factor 4

PT:

Prothrombin time

PTA:

Percutaneous transluminal angioplasty

PTCA:

Percutaneous transluminal coronary angiography

SRA:

Serotonin release assay

TF:

Tissue factor

TTP:

Thrombotic thrombocytopenia purpura

UFH:

Unfractionated heparin

VKA:

Vitamin K antagonist

VLG:

Venous limb gangrene

WISN:

Warfarin-induced skin necrosis

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Authors and Affiliations

  1. Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA

    John R. Bartholomew M.D., F.A.C.C., M.S.V.M.

  2. Departments of Cardiovascular Medicine and Hematology/Oncology, Cleveland Clinic Foundation, Cleveland, OH, USA

    John R. Bartholomew M.D., F.A.C.C., M.S.V.M.

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  1. John R. Bartholomew M.D., F.A.C.C., M.S.V.M.
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Correspondence to John R. Bartholomew M.D., F.A.C.C., M.S.V.M. .

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Editors and Affiliations

  1. Hematologic Oncology and Blood Disorders, Cleveland Clinic, Cleveland, Ohio, USA

    Alan Lichtin

  2. Cardiovascular Medicine and Hematology, Cleveland Clinic, Cleveland, Ohio, USA

    John Bartholomew

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Bartholomew, J.R. (2014). Heparin-Induced Thrombocytopenia. In: Lichtin, A., Bartholomew, J. (eds) The Coagulation Consult. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-9560-4_14

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  • DOI: https://doi.org/10.1007/978-1-4614-9560-4_14

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