Understanding Heparin-Induced Thrombocytopenia

Heparin-induced thrombocytopenia (HIT) is an important and common condition that can occur in anyone exposed to Heparin. It is a pro-thrombotic state with a high risk of thrombosis. HIT is diagnosed by assessing the 4T score, which evaluates the depth and timing of thrombocytopenia, presence of thrombosis, and possible alternative causes. An ELISA test is used to detect HIT antibodies, and a serotonin release assay confirms the diagnosis. Managing HIT involves immediately stopping Heparin anticoagulation and initiating alternative anticoagulants, such as bivalirudin. Treatment is continued until platelet count recovery and for one month if there is no clot or three months if there is a clot. Doppler tests are recommended to detect asymptomatic thrombosis. Best practices include reversing Warfarin if the patient is on it, adding Heparin to the allergy list, and transitioning to DOACs or FondaParinux once platelet counts recover. Long-term avoidance of Heparin is advised, except in specific cases such as long cardiac surgeries.