ABSTRACT
Heparin-induced thrombocytopenia (HIT) is a prothrombotic drug reaction caused by
platelet-activating antibodies. HIT sera often activate platelets without needing
heparin—such heparin-“independent” platelet activation can be associated with HIT
beginning or worsening despite stopping heparin (“delayed-onset HIT”). We address
important issues in HIT diagnosis and therapy, using a recent cohort of HIT patients
to illustrate influences of heparin type; triggers for HIT investigation; serological
features of heparin-independent platelet activation; and treatment. In our cohort
of recent HIT cases (n = 13), low-molecular-weight heparin (dalteparin) was a common causative agent (n = 8, 62%); most patients were diagnosed after HIT-thrombosis had occurred; and danaparoid
was the most frequently selected treatment. Heparin-independent platelet activation
was common (7/13 [54%]) and predicted slower platelet count recovery (>1 week) among
evaluable patients (5/5 vs 1/6; p = 0.015). In our experience with argatroban-treated patients, HIT-associated consumptive
coagulopathy confounds anticoagulant monitoring. Our observations provide guidance
on practical aspects of HIT diagnosis and management.
KEYWORDS
Heparin-induced thrombocytopenia - prothrombotic - danaparoid - fondaparinux - direct
thrombin inhibitors
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Theodore E WarkentinM.D.
Hamilton Regional Laboratory Medicine Program, Room 1-270B, Hamilton Health Sciences,
Hamilton General Site
237 Barton Street East, Hamilton, ON L8L 2X2, Canada
eMail: twarken@mcmaster.ca
