Heparin-Induced Thrombocytopenia Questions & Answers

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5. Jevtic SD, Morris AM, Warkentin TE, Pai M. Heparin-induced thrombocytopenia. CMAJ. 2021 May 17. 193 (20):E736. [QxMD MEDLINE Link]. [Full Text].

6. Visentin GP, Ford SE, Scott JP, Aster RH. Antibodies from patients with heparin-induced thrombocytopenia/thrombosis are specific for platelet factor 4 complexed with heparin or bound to endothelial cells. J Clin Invest. 1994 Jan. 93(1):81-8. [QxMD MEDLINE Link]. [Full Text].

7. Rauova L, Poncz M, McKenzie SE, et al. Ultralarge complexes of PF4 and heparin are central to the pathogenesis of heparin-induced thrombocytopenia. Blood. 2005 Jan 1. 105(1):131-8. [QxMD MEDLINE Link]. [Full Text].

8. Zheng Y, Wang AW, Yu M, Padmanabhan A, Tourdot BE, Newman DK, et al. B-cell tolerance regulates production of antibodies causing heparin-induced thrombocytopenia. Blood. 2014 Feb 6. 123(6):931-4. [QxMD MEDLINE Link]. [Full Text].

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10. Kelton JG, Sheridan D, Santos A, et al. Heparin-induced thrombocytopenia: laboratory studies. Blood. 1988 Sep. 72(3):925-30. [QxMD MEDLINE Link]. [Full Text].

11. Arepally GM. Heparin-induced thrombocytopenia. Blood. 2017 May 25. 129 (21):2864-2872. [QxMD MEDLINE Link].

12. Newman PM, Chong BH. Heparin-induced thrombocytopenia: new evidence for the dynamic binding of purified anti-PF4-heparin antibodies to platelets and the resultant platelet activation. Blood. 2000 Jul 1. 96(1):182-7. [QxMD MEDLINE Link].

13. Warkentin TE. Clinical picture of heparin-induced thrombocytopenia (HIT) and its differentiation from non-HIT thrombocytopenia. Thromb Haemost. 2016 Sep 22. 116 (5):[QxMD MEDLINE Link].

14. Warkentin TE, Sheppard JA, Heels-Ansdell D, Marshall JC, McIntyre L, Rocha MG, et al. Heparin-induced thrombocytopenia in medical surgical critical illness. Chest. 2013 Sep. 144(3):848-58. [QxMD MEDLINE Link].

15. Kadidal VV, Mayo DJ, Horne MK. Heparin-induced thrombocytopenia (HIT) due to heparin flushes: a report of three cases. J Intern Med. 1999 Sep. 246(3):325-9. [QxMD MEDLINE Link]. [Full Text].

16. Heeger PS, Backstrom JT. Heparin flushes and thrombocytopenia. Ann Intern Med. 1986 Jul. 105(1):143. [QxMD MEDLINE Link].

17. Doty JR, Alving BM, McDonnell DE, Ondra SL. Heparin-associated thrombocytopenia in the neurosurgical patient. Neurosurgery. 1986 Jul. 19(1):69-72. [QxMD MEDLINE Link].

18. Rizzoni WE, Miller K, Rick M, Lotze MT. Heparin-induced thrombocytopenia and thromboembolism in the postoperative period. Surgery. 1988 Apr. 103(4):470-6. [QxMD MEDLINE Link].

19. Ling E, Warkentin TE. Intraoperative heparin flushes and subsequent acute heparin-induced thrombocytopenia. Anesthesiology. 1998 Dec. 89(6):1567-9. [QxMD MEDLINE Link].

20. Warkentin TE, Cook RJ, Marder VJ, Sheppard JA, Moore JC, Eriksson BI, et al. Anti-platelet factor 4/heparin antibodies in orthopedic surgery patients receiving antithrombotic prophylaxis with fondaparinux or enoxaparin. Blood. 2005 Dec 1. 106(12):3791-6. [QxMD MEDLINE Link]. [Full Text].

21. Smythe MA, Koerber JM, Mattson JC. The incidence of recognized heparin-induced thrombocytopenia in a large, tertiary care teaching hospital. Chest. 2007 Jun. 131(6):1644-9. [QxMD MEDLINE Link]. [Full Text].

22. Schmitt BP, Adelman B. Heparin-associated thrombocytopenia: a critical review and pooled analysis. Am J Med Sci. 1993 Apr. 305(4):208-15. [QxMD MEDLINE Link].

23. Arepally G, Cines DB. Heparin-induced thrombocytopenia and thrombosis. Clin Rev Allergy Immunol. 1998 Fall. 16(3):237-47. [QxMD MEDLINE Link].

24. Warkentin TE. Heparin-induced thrombocytopenia: a ten-year retrospective. Annu Rev Med. 1999. 50:129-47. [QxMD MEDLINE Link].

25. Warkentin TE, Eikelboom JW. Who is (still) getting HIT?. Chest. 2007 Jun. 131(6):1620-2. [QxMD MEDLINE Link].

26. Warkentin TE, Kelton JG. A 14-year study of heparin-induced thrombocytopenia. Am J Med. 1996 Nov. 101(5):502-7. [QxMD MEDLINE Link].

27. Nand S, Wong W, Yuen B, et al. Heparin-induced thrombocytopenia with thrombosis: incidence, analysis of risk factors, and clinical outcomes in 108 consecutive patients treated at a single institution. Am J Hematol. 1997 Sep. 56(1):12-6. [QxMD MEDLINE Link]. [Full Text].

28. Boshkov LK, Warkentin TE, Hayward CP, Andrew M, Kelton JG. Heparin-induced thrombocytopenia and thrombosis: clinical and laboratory studies. Br J Haematol. 1993 Jun. 84(2):322-8. [QxMD MEDLINE Link].

29. King DJ, Kelton JG. Heparin-associated thrombocytopenia. Ann Intern Med. 1984 Apr. 100(4):535-40. [QxMD MEDLINE Link].

30. Pishko AM, Lefler DS, Gimotty P, Paydary K, Fardin S, Arepally GM, et al. The risk of major bleeding in patients with suspected heparin-induced thrombocytopenia. J Thromb Haemost. 2019 Nov. 17 (11):1956-1965. [QxMD MEDLINE Link].

31. Lewis BE, Wallis DE, Hursting MJ, Levine RL, Leya F. Effects of argatroban therapy, demographic variables, and platelet count on thrombotic risks in heparin-induced thrombocytopenia. Chest. 2006 Jun. 129(6):1407-16. [QxMD MEDLINE Link]. [Full Text].

32. Warkentin TE, Sheppard JA, Sigouin CS, Kohlmann T, Eichler P, Greinacher A. Gender imbalance and risk factor interactions in heparin-induced thrombocytopenia. Blood. 2006 Nov 1. 108(9):2937-41. [QxMD MEDLINE Link]. [Full Text].

33. Colarossi G, Schnöring H, Trivellas A, Betsch M, Hatam N, Eschweiler J, et al. Prognostic factors for patients with heparin-induced thrombocytopenia: a systematic review. Int J Clin Pharm. 2021 Jun. 43 (3):449-460. [QxMD MEDLINE Link].

34. Greinacher A, Farner B, Kroll H, Kohlmann T, Warkentin TE, Eichler P. Clinical features of heparin-induced thrombocytopenia including risk factors for thrombosis. A retrospective analysis of 408 patients. Thromb Haemost. 2005 Jul. 94(1):132-5. [QxMD MEDLINE Link].

35. Obeng EA, Harney KM, Moniz T, Arnold A, Neufeld EJ, Trenor CC 3rd. Pediatric heparin-induced thrombocytopenia: prevalence, thrombotic risk, and application of the 4Ts scoring system. J Pediatr. 2015 Jan. 166 (1):144-50. [QxMD MEDLINE Link].

36. Greinacher A, Lubenow N. Heparin-induced thrombocytopenia. Arnout J, de Gaetano G, Hoylaerts M, et al, eds. Thrombosis: Fundamental and Clinical Aspects. Leuven, Belgium: Leuven University Press; 2003.

37. Warkentin TE. Clinical presentation of heparin-induced thrombocytopenia. Semin Hematol. 1998 Oct. 35(4 suppl 5):9-16; discussion 35-6. [QxMD MEDLINE Link].

38. Warkentin TE, Kelton JG. Delayed-onset heparin-induced thrombocytopenia and thrombosis. Ann Intern Med. 2001 Oct 2. 135(7):502-6. [QxMD MEDLINE Link].

39. Greinacher A, Warkentin TE. Recognition, treatment, and prevention of heparin-induced thrombocytopenia: review and update. Thromb Res. 2006. 118(2):165-76. [QxMD MEDLINE Link].

40. Warkentin TE. An overview of the heparin-induced thrombocytopenia syndrome. Semin Thromb Hemost. 2004 Jun. 30(3):273-83. [QxMD MEDLINE Link].

41. Cuker A, Gimotty PA, Crowther MA, Warkentin TE. Predictive value of the 4Ts scoring system for heparin-induced thrombocytopenia: a systematic review and meta-analysis. Blood. 2012 Nov 15. 120(20):4160-7. [QxMD MEDLINE Link]. [Full Text].

42. Hogan M, Berger JS. Heparin-induced thrombocytopenia (HIT): Review of incidence, diagnosis, and management. Vasc Med. 2020 Apr. 25 (2):160-173. [QxMD MEDLINE Link].

43. Lo GK, Juhl D, Warkentin TE, Sigouin CS, Eichler P, Greinacher A. Evaluation of pretest clinical score (4 T's) for the diagnosis of heparin-induced thrombocytopenia in two clinical settings. J Thromb Haemost. 2006 Apr. 4(4):759-65. [QxMD MEDLINE Link].

44. Cuker A, Arepally G, Crowther MA, Rice L, Datko F, Hook K, et al. The HIT Expert Probability (HEP) Score: a novel pre-test probability model for heparin-induced thrombocytopenia based on broad expert opinion. J Thromb Haemost. 2010 Dec. 8(12):2642-50. [QxMD MEDLINE Link].

45. Harada MY, Hoang DM, Zaw AA, Murry JS, Volod O, Sun BJ, et al. Overtreatment of Heparin-Induced Thrombocytopenia in the Surgical ICU. Crit Care Med. 2016 Aug 4. [QxMD MEDLINE Link].

46. Berry C, Tcherniantchouk O, Ley EJ, et al. Overdiagnosis of heparin-induced thrombocytopenia in surgical ICU patients. J Am Coll Surg. 2011 Jul. 213(1):10-7; discussion 17-8. [QxMD MEDLINE Link].

47. [Guideline] Linkins LA, Dans AL, Moores LK, Bona R, Davidson BL, Schulman S, et al. 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-530S. [QxMD MEDLINE Link]. [Full Text].

48. Lee GM, Arepally GM. Heparin-induced thrombocytopenia. Hematology Am Soc Hematol Educ Program. 2013. 2013:668-74. [QxMD MEDLINE Link].

49. Meyer O, Salama A, Pittet N, Schwind P. Rapid detection of heparin-induced platelet antibodies with particle gel immunoassay (ID-HPF4). Lancet. 1999 Oct 30. 354(9189):1525-6. [QxMD MEDLINE Link].

50. Baroletti S, Hurwitz S, Conti NA, et al. Thrombosis in suspected heparin-induced thrombocytopenia occurs more often with high antibody levels. Am J Med. 2012 Jan. 125(1):44-9. [QxMD MEDLINE Link].

51. Whitlatch NL, Kong DF, Metjian AD, Arepally GM, Ortel TL. Validation of the high-dose heparin confirmatory step for the diagnosis of heparin-induced thrombocytopenia. Blood. 2010 Sep 9. 116(10):1761-6. [QxMD MEDLINE Link].

52. Sheridan D, Carter C, Kelton JG. A diagnostic test for heparin-induced thrombocytopenia. Blood. 1986 Jan. 67(1):27-30. [QxMD MEDLINE Link]. [Full Text].

53. Eichler P, Raschke R, Lubenow N, et al. The new ID-heparin/PF4 antibody test for rapid detection of heparin-induced antibodies in comparison with functional and antigenic assays. Br J Haematol. 2002 Mar. 116(4):887-91. [QxMD MEDLINE Link].

54. Arepally G, Reynolds C, Tomaski A, et al. Comparison of PF4/heparin ELISA assay with the 14C-serotonin release assay in the diagnosis of heparin-induced thrombocytopenia. Am J Clin Pathol. 1995 Dec. 104(6):648-54. [QxMD MEDLINE Link].

55. Chong BH, Burgess J, Ismail F. The clinical usefulness of the platelet aggregation test for the diagnosis of heparin-induced thrombocytopenia. Thromb Haemost. 1993 Apr 1. 69(4):344-50. [QxMD MEDLINE Link].

56. Look KA, Sahud M, Flaherty S, Zehnder JL. Heparin-induced platelet aggregation vs platelet factor 4 enzyme-linked immunosorbent assay in the diagnosis of heparin-induced thrombocytopenia-thrombosis. Am J Clin Pathol. 1997 Jul. 108(1):78-82. [QxMD MEDLINE Link].

57. [Guideline] Cuker A, Arepally GM, Chong BH, Cines DB, Greinacher A, Gruel Y, et al. American Society of Hematology 2018 guidelines for management of venous thromboembolism: heparin-induced thrombocytopenia. Blood Adv. 2018 Nov 27. 2 (22):3360-3392. [QxMD MEDLINE Link]. [Full Text].

58. Hein PA, Lembcke A, Rogalla P. Images in cardiovascular medicine. Multiple thrombosis with aortic occlusion after heparin-induced thrombocytopenia demonstrated by multislice computed tomography. Circulation. 2006 Feb 14. 113(6):e80-3. [QxMD MEDLINE Link]. [Full Text].

59. Warkentin TE, Greinacher A. Management of heparin-induced thrombocytopenia. Curr Opin Hematol. 2016 Sep. 23 (5):462-70. [QxMD MEDLINE Link].

60. Cuker A, Cines DB. How I treat heparin-induced thrombocytopenia. Blood. 2012 Mar 8. 119(10):2209-18. [QxMD MEDLINE Link].

61. Schindewolf M. Fondaparinux in heparin-induced thrombocytopenia: A decade's worth of clinical experience. Res Pract Thromb Haemost. 2019 Jan. 3 (1):9-11. [QxMD MEDLINE Link]. [Full Text].

62. Ho PJ, Siordia JA. Dabigatran approaching the realm of heparin-induced thrombocytopenia. Blood Res. 2016 Jun. 51 (2):77-87. [QxMD MEDLINE Link].

63. Casan JM, Grigoriadis G, Chan N, Chunilal S. Rivaroxaban in treatment refractory heparin-induced thrombocytopenia. BMJ Case Rep. 2016 Aug 12. 2016:[QxMD MEDLINE Link].

64. Skelley JW, Kyle JA, Roberts RA. Novel oral anticoagulants for heparin-induced thrombocytopenia. J Thromb Thrombolysis. 2016 Aug. 42 (2):172-8. [QxMD MEDLINE Link].

65. Cirbus K, Simone P, Austin Szwak J. Rivaroxaban and apixaban for the treatment of suspected or confirmed heparin-induced thrombocytopenia. J Clin Pharm Ther. 2022 Jan. 47 (1):112-118. [QxMD MEDLINE Link].

66. Miyares MA, Davis KA. Direct-acting oral anticoagulants as emerging treatment options for heparin-induced thrombocytopenia. Ann Pharmacother. 2015 Jun. 49 (6):735-9. [QxMD MEDLINE Link].

67. Warkentin TE. High-dose intravenous immunoglobulin for the treatment and prevention of heparin-induced thrombocytopenia: a review. Expert Rev Hematol. 2019 Aug. 12 (8):685-698. [QxMD MEDLINE Link].

68. Junqueira DR, Perini E, Penholati RR, Carvalho MG. Unfractionated heparin versus low molecular weight heparin for avoiding heparin-induced thrombocytopenia in postoperative patients. Cochrane Database Syst Rev. 2012 Sep 12. 9:CD007557. [QxMD MEDLINE Link].

69. Pongas G, Dasgupta SK, Thiagarajan P. Antiplatelet factor 4/heparin antibodies in patients with gram negative bacteremia. Thromb Res. August 2013. 132(2):217-20. [QxMD MEDLINE Link].

70. Audette MD, Glymph DC. Bivalirudin in off-pump coronary artery bypass graft in a patient with heparin-induced thrombocytopenia: a case report of its use. AANA J. 2015 Apr. 83 (2):116-22. [QxMD MEDLINE Link].

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Sancar Eke, MD, FASN Nephrologist, MultiCare Nephrology

Sancar Eke, MD, FASN is a member of the following medical societies: American College of Physicians, American Society of Diagnostic and Interventional Nephrology, American Society of Nephrology, American Society of Transplantation

Disclosure: Nothing to disclose.

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

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: Received salary from Medscape for employment. for: Medscape.

Srikanth Nagalla, MD, MS, FACP Chief of Benign Hematology, Miami Cancer Institute, Baptist Health South Florida; Clinical Professor of Medicine, Florida International University, Herbert Wertheim College of Medicine

Srikanth Nagalla, MD, MS, FACP is a member of the following medical societies: American Society of Hematology, Association of Specialty Professors

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Alexion; Alnylam; Kedrion; Sanofi; Dova; Apellis; Pharmacosmos<br/>Serve(d) as a speaker or a member of a speakers bureau for: Sobi; Sanofi; Rigel.

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 Society of Hematology

Disclosure: Nothing to disclose.

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