Heparin-induced thrombocytopenia following hip and knee arthroplasty

Until recently, both the British Society for Haematology and American College of Chest Physicians recommended platelet monitoring in all surgical patients receiving prophylactic low molecular weight heparin (LMWH) for the early diagnosis of heparin-induced thrombocytopenia (HIT). These guidelines were reversed in 2012 based upon an analysis considering resource expenditure, assay result timeframes, and complications relating to HIT treatment. However, there are no large studies reviewing lower limb arthroplasty patients on an individual basis to determine the incidence of HIT in this patient group. This study investigated 10797 patients who underwent primary hip or knee arthroplasty with LMWH prophylaxis over a 5years period. 32 center dot 6% of patients (n=3515) had platelet counts recorded up to 14d postoperatively with 13 patients (0 center dot 37%) developing thrombocytopenia. Platelet counts recovered spontaneously in five patients, and two patients had other identifiable causes. Only one of the remaining six patients developed thrombosis indicating an incidence of HIT-related thrombosis of 0 center dot 03%. The potential for identifying HIT with platelet monitoring in patients receiving LMWH prophylaxis is low and therefore routine monitoring for HIT is not justified.