Treatment and prevention of heparin-induced thrombocytopenia: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines

Chest. 2012 Feb;141(2 Suppl):e495S-e530S. doi: 10.1378/chest.11-2303.

Abstract

Background: Heparin-induced thrombocytopenia (HIT) is an antibody-mediated adverse drug reaction that can lead to devastating thromboembolic complications, including pulmonary embolism, ischemic limb necrosis necessitating limb amputation, acute myocardial infarction, and stroke.

Methods: The methods of this guideline follow the Methodology for the Development of Antithrombotic Therapy and Prevention of Thrombosis Guidelines: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines in this supplement.

Results: Among the key recommendations for this article are the following: For patients receiving heparin in whom clinicians consider the risk of HIT to be > 1%, we suggest that platelet count monitoring be performed every 2 or 3 days from day 4 to day 14 (or until heparin is stopped, whichever occurs first) (Grade 2C). For patients receiving heparin in whom clinicians consider the risk of HIT to be < 1%, we suggest that platelet counts not be monitored (Grade 2C). In patients with HIT with thrombosis (HITT) or isolated HIT who have normal renal function, we suggest the use of argatroban or lepirudin or danaparoid over other nonheparin anticoagulants (Grade 2C). In patients with HITT and renal insufficiency, we suggest the use of argatroban over other nonheparin anticoagulants (Grade 2C). In patients with acute HIT or subacute HIT who require urgent cardiac surgery, we suggest the use of bivalirudin over other nonheparin anticoagulants or heparin plus antiplatelet agents (Grade 2C).

Conclusions: Further studies evaluating the role of fondaparinux and the new oral anticoagulants in the treatment of HIT are needed.

Publication types

  • Practice Guideline
  • Review

MeSH terms

  • Anticoagulants / adverse effects*
  • Anticoagulants / therapeutic use*
  • Drug Therapy, Combination
  • Evidence-Based Medicine*
  • Fibrinolytic Agents / adverse effects*
  • Fibrinolytic Agents / therapeutic use*
  • Heparin / adverse effects*
  • Heparin / therapeutic use*
  • Humans
  • International Normalized Ratio
  • Platelet Count
  • Risk Factors
  • Societies, Medical*
  • Thrombocytopenia / blood
  • Thrombocytopenia / chemically induced*
  • Thrombocytopenia / diagnosis
  • Thrombocytopenia / drug therapy*
  • Thromboembolism / blood
  • Thromboembolism / chemically induced
  • Thromboembolism / therapy
  • Thrombosis / blood
  • Thrombosis / drug therapy*
  • United States
  • Vitamin K / antagonists & inhibitors

Substances

  • Anticoagulants
  • Fibrinolytic Agents
  • Vitamin K
  • Heparin