Heparin-Induced Thrombocytopenia Follow-up

  • Author: Sancar Eke, MD; Chief Editor: Emmanuel C Besa, MD   more...
 
Updated: Mar 6, 2012
 

Deterrence/Prevention

Heparin-induced thrombocytopenia (HIT) is a life- and limb-threatening medical emergency. However, the consequences of heparin-induced thrombocytopenia (HIT) are largely preventable with early recognition and proper treatment. The immediate cessation of all forms of heparin therapy is essential in patients with clinically suspected heparin-induced thrombocytopenia (HIT). However, discontinuation of heparin alone is not adequate treatment.

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Complications

  • DVT
  • Pulmonary embolism
  • MI
  • Occlusion of limb arteries (possibly resulting in amputation)
  • CVAs (eg, stroke, transient ischemic attack [TIA])
  • Skin necrosis
  • End-organ damage (eg, adrenal, bowel, spleen, gallbladder, or hepatic infarction; renal failure)
  • Death
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Prognosis

Until recently, the mortality rate in heparin-induced thrombocytopenia (HIT) has been reported as high as 20%, and a similar percentage of patients survived with major complications, including limb loss or stroke. Recent improvements in early diagnosis and treatment have resulted in a better prognosis, but the mortality and major complications of heparin-induced thrombocytopenia (HIT) are still as high as 6-10%.[53]

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Patient Education

To prevent thrombosis, patients with heparin-induced thrombocytopenia (HIT) should receive anticoagulation with agents other than heparin or LMWH. Because early detection seems to improve outcome, it is recommended that all patients on heparin should have frequent monitoring of their platelet counts.

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Contributor Information and Disclosures
Author

Sancar Eke, MD  Physician in Nephrology and Hypertension, West Virginia

Sancar Eke, MD is a member of the following medical societies: American College of Physicians and Massachusetts Medical Society

Disclosure: Nothing to disclose.

Coauthor(s)

Sarah K May, MD  Consulting Staff, Department of Hematology-Oncology, Caritas Carney Hospital, Commonwealth Hematology-Oncology PC

Disclosure: Nothing to disclose.

Specialty Editor Board

Paul Schick, MD  Emeritus Professor, Department of Internal Medicine, Jefferson Medical College of Thomas Jefferson University; Research Professor, Department of Internal Medicine, Drexel University College of Medicine; Adjunct Professor of Medicine, Lankenau Hospital

Paul Schick, MD is a member of the following medical societies: American College of Physicians, American Heart Association, American Society of Hematology, International Society on Thrombosis and Haemostasis, and New York Academy of Sciences

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Chief Editor

Emmanuel C Besa, MD  Professor, Department of Medicine, Division of Hematologic Malignancies, Kimmel Cancer Center, Jefferson Medical College of Thomas Jefferson University

Emmanuel C Besa, MD is a member of the following medical societies: American Association for Cancer Education, American College of Clinical Pharmacology, American Federation for Medical Research, American Society of Clinical Oncology, American Society of Hematology, and New York Academy of Sciences

Disclosure: Nothing to disclose.

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Ultrasonographic image of a deep vein thrombosis (DVT).
Sequential images demonstrate treatment of iliofemoral deep venous thrombosis due to May-Thurner (Cockett) syndrome. Far left: View of the entire pelvis demonstrates iliac occlusion. Middle left: After 12 hours of catheter-directed thrombolysis, an obstruction at the left common iliac vein is evident. Middle right: After 24 hours of thrombolysis, a bandlike obstruction is seen; this is the impression made by the overlying right common iliac artery. Far left: After stent placement, image shows wide patency and rapid flow through the previously obstructed region. Note that the patient is in the prone position in all views. (Right and left are reversed.)
Ventilation-perfusion scan. Left image: Posterior view of normal findings on ventilation-perfusion scan. Right image: Posterior view of a perfusion scan that reveals a perfusion defect in the left upper quadrant. The defect in the middle of the image is due to the position of the heart.
Helical computed tomography scan of the pulmonary arteries. A filling defect in the right pulmonary artery is present, consistent with a pulmonary embolism.
 
 
 
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