ABSTRACT
INTRODUCTION Heparin-induced thrombocytopenia (HIT) presents a unique situation: heparin causes the very complications that its use was intended to prevent, for example, pulmonary embolism, stroke, and limb gangrene. Furthermore, several treatment paradoxes pose serious management pitfalls (Table 12.1). This chapter summarizes our treatment approaches, with emphasis on practical management issues. We wish to highlight two important issues. First, HIT is a syndrome of increased thrombin generation (“hypercoagulability state”). Accordingly, we emphasize the use of rapidly acting anticoagulant drugs that control thrombin generation in HIT. Second, there is increasing evidence that in most patients in whom testing for HIT antibodies is requested, a non-HIT diagnosis ultimately is made (Lo et al., 2006; Greinacher et al., 2007). Thus, the risk of failing to prevent a HIT-associated thrombosis (through timely use of a nonheparin anticoagulant) must be balanced against the risk of inducing adverse effects from using another anticoagulant, for example, bleeding complications (for which no antidote exists).
