Heparin-induced thrombocytopenia: present and future

Abstract

Heparin-induced thrombocytopenia (HIT) is a prothrombotic and potentially devastating complication of heparin therapy due to formation of platelet-activating antibodies against complexes of platelet factor 4 and heparin. Over the last several decades, great advances in our understanding of HIT have elevated a once enigmatic syndrome, the mere existence of which was doubted by the medical community, to a well-characterized disorder. Nevertheless, critical questions remain unanswered. The objective of this review is to examine our current understanding of the epidemiology, pathophysiology, diagnosis, and management of HIT and to highlight areas of future inquiry.

Diagnostic value of immunoassays for heparin-induced thrombocytopenia: a systematic review and meta-analysis

“…[1][2][3][4] HIT is a life-threatening complication of heparin therapy that affects a significant number of patients. 5 It is associated with a high morbidity and mortality because of a massive pro-coagulant state, with a high incidence of extensive venous and arterial thrombosis, limb loss, and even death. 6,7 Suspicion of HIT requires an immediate diagnostic workup to prevent severe complications.…”

The Clinical Utility of the Heparin Neutralization Assay in the Diagnosis of Heparin-Induced Thrombocytopenia

“…1,2 These antibodies recognize neoepitopes within the heparin-PF4 complex and activate platelets as well as monocytes, 2,3 resulting in the generation of thrombin and platelet-fibrin thrombi. 4,5 Heparin-induced thrombocytopenia affects a significant number of patients, 6 has a high incidence of clinically significant venous and arterial thrombosis, and is associated with high morbidity and mortality. 1,7 Given the widespread use of heparin and the frequency of thrombocytopenia in hospitalized patients receiving heparin, 8 HIT is a common diagnostic consideration in many hospitalized patients.…”

Elevated Heparin Induced Antibodies are More Common in Diabetic Patients With Vascular Disease

“…The 14C-Serotonin release assay (SRA) is a functional test to detect antibodies capable of activating platelets which has a specificity and sensitivity of more than 95%. Despite being one of the reference standard tests for the detection of HPF4 antibodies, this test is not readily available in all laboratories [31][32][33]. We did not utilize the functional SRA tests to determine if the associated thrombotic events were due to immunogenic heparin-induced antibodies capable of activating platelets.…”