Specific Treatment Parenteral anticoagulant therapy intra-aortic balloon pump, extracorporeal membrane oxygenation, ventricular assist device). Presence of an indwelling intra-arterial device (e.g. antibiotics, glycoprotein IIb/IIIa antagonists, quinine, etc.).ĭisseminated intravascular coagulation (DIC). Non-heparin drugs known to cause thrombocytopenia (e.g. The differential diagnosis includes other conditions that cause thrombocytopenia in hospitalized patients: Negative high clinical probability ⇒ HIT indeterminateĪdapted from Cuker A & Crowther MA, 2009 American Society of Hematology Clinical Practice Guideline on the Evaluation and Management of Heparin-Induced Thrombocytopenia. Negative intermediate clinical probability ⇒ HIT unlikely resume heparin consider alternative diagnosesī. Intermediate/high clinical probability ⇒ Discontinue heparin start alternative parenteral anticoagulant obtain immunologic assayĪ. Low clinical probability ⇒ HIT unlikely continue heparin consider alternative diagnosesī. PF4, platelet factor 4 OD, optical density SRA, serotonin release assay HIPA, heparin-induce platelet activation assay Diagnostic and initial treatment algorithmĪ. See Table II: The 4 T’s: A clinical probability model. If the patient is on warfarin at the time HIT is diagnosed, it should be reversed with vitamin K.Īvoid prophylactic platelet transfusions. Initiate an alternative parenteral anticoagulant.ĭo not start an oral anticoagulant until the platelet count has normalized. Stop all heparin immediately, including heparin flushes. Such as infection, other medications known to cause thrombocytopenia, recent cardiopulmonary bypass, etc.Ībsence of petechiae and other significant bleeding. May be <20 x 10 9/L in cases associated with DIC.Ībsence of alternative causes of thrombocytopenia. In patients with a previous recent heparin exposure, usually within the last 30 days. From highest platelet count after heparin exposure platelet count fall is 30-50% in 10% of cases.įall in platelet count begins 5-14 days after heparin exposure.įall in platelet count begins within 24 hours of heparin exposure.
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