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Heparin-Induced Thrombocytopenia (HIT)

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Anticoagulation and Hemostasis in Neurosurgery

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Abstract

Heparin-induced thrombocytopenia (HIT) is an immune response whereby antibodies are formed to the complex of platelet factor 4, a protein released upon platelet activation, and heparin. This is a complex syndrome that requires immediate and knowledgeable medical management to avoid serious adverse outcomes. Neurological complications in patients with HIT are not uncommon and there should be heightened stroke awareness for at least 2 weeks following a diagnosis of HIT. HIT patients with stroke experience poorer outcomes and increased mortality. HIT should also be considered in the differential diagnosis when thrombotic stroke occurs. The diagnosis of HIT is heavily dependent on the clinical evaluation. Scoring systems aid in the clinical diagnosis and the decision to perform laboratory testing. There are two types of laboratory tests for HIT, immunoassays and platelet function assays, both of which provide different information needed for an accurate diagnosis. Removal of heparin alone is not sufficient to halt the pathology of HIT. A potent intravenous thrombin inhibitor (argatroban, bivalirudin) is used to treat HIT thrombosis. Other non-heparin anticoagulants are used to manage patients suspected of HIT for the prevention of thrombosis. The expanded use of low molecular weight heparins and non-heparin anticoagulants over heparin, strategies to reduce exposure to heparin, and strategies to reduce platelet activation will reduce the frequency of the occurrence of HIT.

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Authors and Affiliations

  1. Departments of Thoracic & Cardiovascular Surgery and Pathology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, 60153, USA

    Jeanine M. Walenga Ph.D.

  2. Department of Pathology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, 60153, USA

    M. Margaret Prechel Ph.D.

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  1. Jeanine M. Walenga Ph.D.
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  2. M. Margaret Prechel Ph.D.
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Correspondence to Jeanine M. Walenga Ph.D. .

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Editors and Affiliations

  1. Stritch School of Medicine, Loyola University, Maywood, Illinois, USA

    Christopher M. Loftus

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Walenga, J.M., Prechel, M.M. (2016). Heparin-Induced Thrombocytopenia (HIT). In: Loftus, C. (eds) Anticoagulation and Hemostasis in Neurosurgery. Springer, Cham. https://doi.org/10.1007/978-3-319-27327-3_14

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  • DOI: https://doi.org/10.1007/978-3-319-27327-3_14

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