Journal
HEMATOLOGY-ONCOLOGY CLINICS OF NORTH AMERICA
Volume 21, Issue 4, Pages 589-+Publisher
W B SAUNDERS CO-ELSEVIER INC
DOI: 10.1016/j.hoc.2007.06.004
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Heparin-induced thrombocytopenia (HIT) is an immune-mediated adverse drug effect that is characterized by platelet activation, hypercoagulability, and a resulting increased risk for thrombosis, both venous and arterial. This disorder is autoimmune-like, because the target antigen is a multimolecular complex of the self protein, platelet factor 4, and heparin. HIT usually begins 5 to 10 days after starting heparin especially when administered intra- or perioperatively, although a rapid onset of thrombocytopenia can occur if heparin is given to a patient with circulating HIT antibodies that resulted from a recent heparin exposure. The clinical diagnosis is supported if heparin-dependent, platelet-activating antibodies are detectable. Treatment includes cessation of heparin and use of an alternative non-heparin anticoagulant, such as danaparoid, lepirudin, or argatroban. Warfarin must be avoided or postponed, as the acute phase of HIT poses a high risk for coumarin necrosis, particularly limb loss due to venous limb gangrene.
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