The diagnosis of heparin-induced thrombocytopenia requires stopping of all forms of heparin, including removal of heparin-coated catheters or use of low molecular weight heparins.
Once heparin is stopped, the platelet count should begin to increase in two to five days. Even after the heparin is stopped, the patient continues to be at high risk of heparin-induced thrombocytopenia-related clotting for the next 30 days. Because of this clotting risk, the patient often needs alternative anticoagulation, depending on his or her clinical circumstances.
Use of oral anticoagulation with warfarin alone should not be used in patients with this condition because of the high risk of developing warfarin-induced skin necrosis and gangrene in the veins of the limbs. Heparin-induced Thrombocytopenia. Nephrologists encounter HIT in the care of end-stage renal disease ESRD patients because heparin is a routine anticoagulant in hemodialysis.
A functional assay e. The more common antigen assay e. Thrombin-specific inhibitors also prolong the INR, but this effect is particularly pronounced with argatroban [ 48 ].
Thus, during the transition from argatroban to oral anticoagulation special precautions must be taken [ 49 , 50 ]. Finally, there is recent evidence that a novel synthetic heparin pentasaccharide, fondaparinux, which does not cross-react with HIT antibodies [ 51 ], can be successfully used for the treatment of patients with HIT [ 52 , 53 ]. However, additional controlled clinical studies are required to further evaluate the safety and efficacy of this agent in patients with HIT.
The analysis of the literature data reveals that heparin-induced thrombocytopenia is not only a common but also a serious complication of heparin therapy with a high rate of morbidity and mortality.
Its prompt clinical and laboratory recognition is thus essential in order to stop heparin use immediately and commence an alternative anticoagulant. The low molecular weight heparinoid, danaparoid, and the thrombin-specific inhibitors, lepirudin and argatroban, have been shown to be effective in HIT patients.
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